Heart-Brain team collaborates to prevent stroke recurrences in PFO patients
PULSE Issue 44 | January 2025
When 40-year-old Mdm Lem visited her father in the hospital abroad last November, she never imagined she would become a patient herself. What began as a routine morning by her father’s bedside took a sudden turn when she was suddenly struck by severe giddiness, intense nausea, and an inability to stand without assistance.
An urgent brain Magnetic Resonance Imaging (MRI)1 scan revealed the shocking truth – Mdm Lem had suffered an ischemic stroke2, which occurs when the blood supply to part of the brain is blocked or reduced. Despite a week-long hospital stay and extensive tests, the cause remained a mystery until her return to Singapore.
Seeking answers, Mdm Lem consulted Adj Asst Prof Benjamin Tan, Consultant, Division of Neurology, Department of Medicine, National University Hospital (NUH). After initial tests suggested an abnormal connection within her heart, she was referred to Asst Prof Lim Yinghao, Consultant, Department of Cardiology, National University Heart Centre, Singapore (NUHCS).
The breakthrough came when the Heart-Brain team from NUHCS and NUH collaborated to confirm Mdm Lem's diagnosis - Patent Foramen Ovale (PFO), a condition commonly known as a "hole in the heart". This condition allows small blood clots to pass between heart chambers, potentially obstructing blood flow and causing strokes when they reach the brain.
While PFO affects about 25% of the general population, a recent study conducted by the Heart-Brain team of NUHCS and NUH specialists reveals that this prevalence significantly increases to approximately 40% in young patients with unexplained ischemic strokes2. Each year, the team sees around 75 young adults with unexplained strokes, carefully considering PFO as a potential cause. Most individuals with PFO never experience symptoms or require treatment. However, as in Mdm Lem’s case and the high profile PFO case of then 25-year-old model, Hailey Bieber, a stroke can be the first sign of this heart condition.
Faced with the risk of a more severe stroke in the future, Mdm Lem opted for a minimally invasive PFO device closure procedure, performed by Asst Prof Lim Yinghao. Major international studies in recent years found that the identification of carefully-selected patients can significantly reduce their risk of recurrent strokes through PFO closure, and the Heart-Brain team also confirmed the effectiveness of this through a study published in October 2023.
A rising number of patients have benefitted from this PFO device closure procedure. Last year alone, over 30 patients successfully underwent PFO device closure procedures, performed by a dedicated team of experts at NUHCS.
This success stems from an increased awareness of the intricate Heart-Brain connection in such crucial conditions, made possible by the multidisciplinary team that ensures the right patients are identified for this potentially life-saving treatment.
Just one day after her procedure in May of 2024, Mdm Lem was discharged well, and began a smooth recovery. That same month, she travelled abroad with her family, and even conquered a mountain hiking tour. Today, she treasures every moment with her young sons, aged 6, 12, and 14, grateful that the timely PFO closure procedure has greatly reduced her risk of a future stroke.
The story of Mdm Lem’s recovery highlights the strength of collaboration between cardiologists and neurologists and the importance of their interconnected expertise in modern medicine. By bridging the gap between heart and brain health, the focus falls not only on stroke treatment, but also preventing stroke recurrence and giving young patients like Mdm Lem a chance at a healthier future.
Read Mdm Lem's full story here
1. Magnetic Resonance Imaging (MRI) – Non-invasive technique using strong magnetic fields and radio waves to create detailed images of the body for diagnosis and evaluation of medical conditions.
2. Ischemic strokes – A type of stroke that occurs when blood clot or fatty plaque blocks an artery leading to the brain.
