My husband Joe, 38, was diagnosed with pulmonary stenosis when he was an infant. Apparently in his first few months of life he turned blue once and was taken to the hospital where the diagnosis was made. He had a heart catheterization when he was a boy, but otherwise the condition has simply been monitored. His mother tells me that she was quite concerned as a child about how to care for him and a nurse told her that he would know when to stop and rest and, indeed, he is still someone who will stop and take a nap when he gets too tired or when it's very hot outside. When he was about 30 Joe took on an active exercise schedule (running) which he has kept up fairly regularly since then. His running has always concerned me a bit, but his cardiologists have insisted that it is fine and of course it is important for him to get exercise for his heart and for overall health.

Last fall when Joe was 38 he was diagnosed with a TIA (transient ischemic attack) and admitted to the hospital for four days of Heparin IV, monitoring, and work up. An MRI showed previous evidence of one or more small TIAs in addition to the present one.

The doctors were unable to detect any heart arrhythmia or any clotting problems in his legs or carotid arteries. Tests for blood clotting disorders also turned up negative. Instead, while doing a TEE (trans-esophageal echogram) they discovered that he has a patent foramen ovale (apparently present in about 15% of the adult population) and an atrial aneurysm. They theorized that the atrial aneurysm produced small clots which passed through the patent foramen ovale and, in the case of the TIAs, entered Joe's brain.

He has been treated with Coumadin since and, we're told, will be on Coumadin indefinitely. His present cardiologist does not feel that surgery or catheterization is presently necessarily. After doing some reading on my own, I suspect that is because either the size of the PFO is too small to warrant it, or they are waiting to see if Joe has further TIAs (or full blown stroke?) while on the Coumadin. He continues to have miniscule but visible blood spots on his fingernails, even while on the Coumadin. Needless to say, I am not happy with this picture!

I have a number of questions about Joe's condition and prognosis, and I have questions about the possible genetic implications for the children we would like to begin having in the next year or two. The advice and experience of other members of the list would be enormously helpful in that regard.