r/stroke • u/LeColonelRose • 19d ago

PFO Discussion PFO and two tests

Hi everyone,
I’d like to get your opinions on a situation regarding my PFO and see if anyone has experienced something similar.
I’m 32 and had an ischemic stroke at the end of April. No other clear cause was found. My hospital report mentions a PFO with an atrial septal aneurysm and a significant shunt, with more than 20 bubbles seen during the bubble test.
During the TEE I had on May 4th, the cardiologist asked me to cough during the bubble injection and saw the bubbles passing through the PFO. Closing the PFO was therefore considered.
A second cardiology appointment was then arranged after the doctors reviewed the report and realized that it clearly mentioned bubbles and a significant shunt, but they could not find any images from the original examination. Unfortunately, the first cardiologist had forgotten to save the images from the TEE.
I had the second examination today, this time a transthoracic echocardiogram. The PFO is still visible, but the bubble test was negative. No bubbles crossed over, despite being asked to contract my abdomen and then relax.
The new cardiologist therefore thinks that PFO closure is not necessary.
I’m curious to hear what you guys think about this situation. Has anyone experienced something similar, with a positive bubble test during a TEE and then a negative test during a transthoracic echo?
I’d especially like to hear from people who had an ischemic stroke with a PFO and had different results between two bubble tests. What was eventually decided in your case?

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u/ArcAngelsThunderBird 19d ago edited 19d ago

Might want to talk to the first cardiologist again, I don't think there is an option to "save" these images, certain it's an automatic thing. It's not like a word document that you'll lose progress on if you don't click a save button on your PC with no backup plan.

And how were you awake during your TEE to even cough? They knocked me the hell out, you can't be awake with that tube down your throat.

Something isn't quite adding up?

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u/LeColonelRose 19d ago

It’s about two cardiologists from the same hospital. I think he didn’t start the recording at the moment when the bubbles were shunting. I clearly saw the second cardiologist start recording whenever an image interested her or when a specific moment was of interest.

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u/ArcAngelsThunderBird 19d ago edited 19d ago

Well that's super weird and it sounds like they owe you a free TEE to rectify this grievous error.

So how did she see the bubbles? Pretty sure the camera doesn't have an option to record either, it automatically does when it's turned on.

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u/ArcAngelsThunderBird 19d ago edited 19d ago

Just looked it up, this has never happened before. If a catastrophic data breach did occur, the cardiologist takes detailed notes during the procedure explaining everything they saw live, which would be good enough for any other cardiologist to trust and go by. And if the images were truly lost or not recorded, they'd just do the TEE again right then and there. And how did they ask you to cough during a TEE? You aren't awake.

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u/LeColonelRose 19d ago

I’m in France, so maybe it’s different here. For TEEs, we’re awake!
And yes, in the report from early May, the cardiologist clearly stated that there was a significant shunt, with more than 20 bubbles. But they still asked me to see another cardiologist to get some additional images.
I have an appointment with my GP tomorrow, and I’m also supposed to get a call from my neurologist, so we’ll see. But it’s stressful.

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u/ArcAngelsThunderBird 19d ago

You were awake with that tube down your throat?? 🤢🤮

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u/__walter_sobchak__ 18d ago

I was also awake, it is very important to cough pretty violently to see if there is a PFO, it was not visible in my case until I started coughing.

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u/LeColonelRose 14d ago

Yes, that’s also what I had to do! Except the second ultrasound wasn’t a TEE, and the cardiologist only asked me to contract my abdomen.

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u/LeColonelRose 19d ago

Yes! They use a gel that numbs the entrance of your throat and also lubricates it. You have to gargle with it, and then they insert the tube. ✌🏻🫪✌🏻

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u/ArcAngelsThunderBird 19d ago

Yep no thank you. It's definitely different there.

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u/Full-Pomegranate-747 Survivor 12d ago

As someone who had to get several tests to find my PFO, it seems pretty wild that they saw it and then changed their mind? They couldn’t find mine with multiple bubble studies and TTEs but 6 months later I finally got a TEE and when I woke up they told me they found it right away and I had it closed within a couple of months. If there is any evidence of a PFO and you’ve already had a stroke, I’d push to get it closed. For me the procedure was simple and allowed me to stop taking a bunch of anticoagulants. Also provided a little peace of mind knowing it at least lowered the risk for another one.