Brief Answer:
I would explain as follows:

Detailed Answer:

Hello!

Thank you for asking on HCM!

Regarding your concern, I would explain as follows:

(1) You have a cardiac abnormality that is called patent foramen ovale (PFO); that is an abnormal communication between two cardiac chambers (atria). The right to left shunt means that venous blood from the right heart (which normally should pass to the lungs for releasing carbon dioxide, and carrying oxygen), is partially shunting through that interatrial defect (PFO), and mixed directly with arterial blood of the left atrium (which normally comes from pulmonary veins to the left heart). Normally during fetal life, foramen ovale is open and helps to maintain blood circulation to the left heart and subsequent arterial vessels, as the lungs are not functional. But after birth, as the lungs gain their functionality and start breathing, foramen ovale is first functionally and then also structurally closed.
If closing process is failed, then an interatrial "hole", interatrial defect, or patent foramen ovale (PFO) results. This is in fact the most common congenital heart disease.

(2) If interatrial communication is relatively significant, it is associated with cardiac chambers dilatation, possible cardiac arrhythmias (supraventricular), impairment of pulmonary blood circulation, and subsequent pulmonary hypertension. This leads to invertion of blood shunting, from left to right (as a consequence of pressure gradient between left and right sides), to right to left and mixure of arterial and venous blood. That last event is associated with cianosis, dyspnea (shortness of breathing), and is in fact a marker of very advanced disease clinical course.

So, the answer is: Yes! This is the reason you get out of breath at times.

(3) Patent foramen ovale may be a source of cardio-embolic events (as a result of paradoxical embolism, that is thrombus travelling from the venous system to arterial system through patent foramen ovale), and even from thrombus generation at the site of PFO. This may be the reason of your recurrent strokes.
Your docrot has made the right decision to recommend you anticoagulation. Warfarin is going to be your permanent therapy to prevent new cardioembolic event (including stroke).

You need only to be careful as Topamax may lower Warfarin effect, and a close monitoring is necessary when using them concomitantly.

Meanwhile Aspirin ans Plavix probably should be avoided by your therapy, when continuing with Warfarin (increased risk of bleeding).

(4) Regarding a definite treatment of PFO, it depends on cardiac ultrasound parameter (interatrial defect dimension and anatomy, level of blood shunting, severity of pulmonary hypertension, etc). A comprehensive evaluation should be done by your cardiologist. There is a surgica loption to close the defect, and another transcatheter option for closing PFO utilizing special devices.

Medical therapy is needed to control possible atrial arrhythmias, congestion, pulmonary circulation, etc

You have to talk with your attending doctors about these issues.

Hope to have been helpful!

Feel free to ask me whenever you need. Greetings! Dr. Iliri

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Brief Answer:
You are welcome!

Detailed Answer:

You are welcome!

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