Sixteen years ago, Phoebe Dow was a 19-year-old waitress when she suffered a stroke resulting from a common birth defect – a small hole between the top two chambers of the heart, which can sometimes allow a blood clot to travel through the hole and up into the brain.

Today, Dow is a 35-year-old newlywed and accountant who hasn’t had any issues with her heart since the November 2005 incident, thanks to a patent foramen ovale (PFO) closure performed by理查德·斯莫林,医学博士,professor and the James D. Woods Distinguished Chair in Cardiovascular Medicine with McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth Houston).

陶氏说：“我很幸运，斯莫林博士做到了 - 这是一个'正确的地方，正确的时间'。”“并不是每个人都从PFO关闭中受益，但我当然有。对我来说，这是一种挽救生命的待遇。”

Dow was among nearly 1,000 patients to participate in a national, randomized clinical trial – known as the RESPECT trial – led locally by Smalling, which over the course of 12 years compared outcomes between patients who received the PFO closure with medical therapy versus patients who received medical therapy alone. The results from this trial and five others conducted globally from 2000-2017 were analyzed in apaper最近出版The Journal of the American Medical Association，这是由Smalling和其他21个合着的.

TheJAMAstudy found that the application of a multivariable, causal classification system to these trial results could distinguish patients who may benefit from PFO closure from those unlikely to benefit.

“Hopefully, this will increase the number of PFO-associated stroke patients who have access to therapy,” said Smalling, who is also director of Interventional Cardiovascular Medicine in the Division of Cardiology with McGovern Medical School and a cardiologist at Memorial Hermann-Texas Medical Center.

PFO-associated strokes comprise approximately 10% of all ischemic strokes in adults ages 18 to 60. In a PFO closure, a device, often guided by a catheter, is moved through a vein in the upper part of the leg to the location of the defect in the heart. The device is deployed to seal the hole and remains in the heart permanently, effectively stopping clots which have formed in the legs or pelvic regions from reaching the brain.

为了确定哪些患者将从该手术中受益，研究人员使用了矛盾栓塞（绳索）评分的风险，这是一个10点评分系统，其中较高的分数反映了年龄beplay苹果手机能用吗较小和缺乏心房颤动等血管危险因素以及PFO--相关的中风因果可能性（Pascal）分类系统，将绳索评分与高风险的PFO特征结合在一起 - 心房隔室动脉瘤（心脏上两个上腔之间的墙壁异常移动的部分）或大尺寸的分流器– to classify patients into three categories of the risk of stroke related to the patient’s anatomy: unlikely, possible, or probable.

在18至60岁患有PFO相关的中风的患者中，中风被归类为“可能”或“可能”与PFO相关的患者，设备关闭后第二笔中风的风险降低，使他们最大可能会从该程序中受益。

According to Smalling, the classification system is significant because, while PFO closures were already known to decrease overall risk of stroke recurrence, the best treatment for any individual is often unclear. He hopes these findings will put physicians nationwide more at ease and confident about recommending the procedure for their patients with PFO-associated stroke.

“This study puts a lot of objectivity into the decision-making process for physicians and patients,” Smalling said. “What it shows is that, in patients who have had a stroke, if you’re young and you have an atrial septal aneurysm or a large shunt, you need to get your PFO closed to prevent additional strokes.”

The findings come more than five years after the Food and Drug Administration in 2016 approved the PFO treatment for use in all patients, thanks in part to testimony given by Dow and several other patients who found it successful. With the latest study, Dow hopes even more stroke patients will become aware of the treatment as a potential option.

Dow has come a long way since her stroke. She graduated from Sam Houston State University in 2014 with an accounting degree and has been working with the same employer for 11 years. In December 2020, she got married, and she now lives with her husband in Cypress, ready for what the future holds.

陶氏说：“当我中风时，它叫醒了我，使我意识到要更加认真地认真对待生活。”“当时，我没有很多其他选择，但是回顾过去，无论如何，我也会做出同样的选择参加审判。今天，我仍然能够以某种方式有所作为。”

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