Hole in heart could explain Penguins defenseman Letang's stroke
Kris Letang is so health-conscious that he limits his alcohol intake to one glass of wine per year, a spartan regimen unheard of for a hockey player. He is known as a workout freak who stays in top condition year-round.
But neither his diligence nor personal habits could plug a hole in his heart known as PFO that might have caused the Penguins' 26-year-old All-Star defenseman to suffer a stroke last week.
PFO, or patent foramen ovale, affects 20 to 25 percent of Americans, according to doctors. Some of the holes have a flap-like opening; others do not.
All babies have the hole before they are born. After birth, the hole usually closes within 72 hours, sometimes with the first breath.
“But with up to a quarter of patients, the hole doesn't close,” said Dr. John Girod, a cardiologist at St. Clair Hospital in Mt. Lebanon. Even when the flap remains open, “most of the time it's of no consequence,” he said.
It might have been of consequence for Letang, who was diagnosed with a small hole between his heart's upper (atrial) chambers, the Penguins said.
The team on Friday announced that Letang suffered a stroke, perhaps as early as Jan. 30. He missed a game in Los Angeles that night and continued to feel ill, missing Saturday's game in Phoenix. A series of tests there and in Pittsburgh confirmed the stroke. Letang is expected to miss at least six weeks.
Dr. Dharmesh Vyas, an orthopedic surgeon who is part of the Penguins' medical team, accompanied the club on the road last week. The Penguins are one of two teams — Chicago is the other — to travel with their own doctors.
“Strokes in young adults are rare,” said Dr. Barry Love, director of the congenital cardiac catheterization laboratory at Mount Sinai Medical Center in New York City.
Love said risk factors such as high blood pressure and high cholesterol usually seen with older stroke patients rarely lead to strokes among those younger than 50.
Irregular heart rhythm (atrial fibrillation) is another minimal risk factor for the young, he said.
That leaves PFO as a possible cause. PFO, Love said, “can allow small clots made in the veins that would normally be filtered harmlessly by the lungs to pass to the left side of the heart directly to the brain, causing a stroke.”
He added, “It is difficult to prove that a given stroke came from a PFO.”
“Clearly not everybody (with PFO) is having a stroke,” said Dr. Harsimran Singh, director of adult congenital heart disease at Weill Cornell Medical College at New York Presbyterian Hospital.
He said a cryptogenic stroke, which has no known causes or risk factors, “likely” can be caused by PFO.
“In a patient who is young like a hockey player and has no other risk factors, and everything looks OK, it definitely becomes a high possibility,” said Singh, who has no firsthand knowledge about Letang.
It is not known whether Letang was diagnosed with other risk factors.
Singh and others noted a split in the medical community about whether surgery to repair the hole would minimize the risk of a stroke or prevent another stroke.
Two famous stroke victims, former New England Patriots linebacker Tedy Bruschi and rock singer and TV personality Bret Michaels, a Butler native, recovered and had their PFOs closed.
Bruschi suffered a stroke in February 2005 at age 31. He returned to the field the following season and played another three seasons.
Although Love said recent clinical trials have failed to prove an advantage to PFO closure over aspirin or stronger blood thinners, the constant threat of flying sticks, skates and pucks would prompt him to recommend that Letang undergo the procedure.
“If Kris Letang were my patient, I would not want him on blood thinners while playing hockey,” Love said.