| I found this article in the Guardian after commenting on the other one. I'm leaving my comments there but this article has a different explanation. |
With elections due on March 28, the health of the prime minister has become a big issue. Haim Lotem, the head of cardiology at Jerusalem's Hadassah hospital, said the hole, measuring between one and two millimetres, was a minor birth defect found in about a quarter of the population. Doctors would use a catheter to insert an "umbrella like" device that seals the hole, which is in the partition wall between the upper chambers of Mr Sharon's heart. The procedure, guided by a small camera inserted through the oesophagus, requires anaesthetic and takes 30 minutes.
| This is different from the other article. Here goes: This 'hole' is an atrial septal defect (ASD). In fetal life, we have a connection from the right atrium to the left to shunt blood away from the fetal lungs. In the first few minutes after birth, we close this hole. Failute to do so can be bad if the remaining shunt (flow through the ASD) is large, but not if it's small. Perhaps 1% of adults have a small ASD and don't know it, and usually it doesn't cause a problem. Back 20-30 years ago one needed major open heart surgery to close an ASD, so you did so only if it was a major problem. The procedure here is relatively new but it works very well: you put a venous catheter in through the femoral vein (in your thigh) and advance the catheter to the right atrium. You run an umbrella through the catheter up to the ASD, and then lodge the umbrella in the hole. That closes it. You watch this via a transesophageal echocardiogram (TEE). That's also new in the last few years. It's an echocardiogram done with a probe in the mid-esophagus. It uses sound waves (not a camera as the Guardian idiot reporter says) to paint real-time pictures of the heart. That gives you a great picture of the heart from the back end, much clearer for an ASD than from the chest side as you get with a standard echocardiogram. You also get a Doppler flow measurement across the ASD with the TEE, and when the umbrella is in you can see the flow go away. |
| That's total crap. What happened is that Mr. Sharon had a right-sided embolus (that is, a clot that floated into the right atrium) that went from the right atrium to the left through the ASD, thence out the left ventricule and up to his brain. That can happen and it's one of the things we're taught to look for in someone who's had a first stroke -- look for an ASD. In this setting it makes sense to close the ASD even if it's 'small', especially if the embolus came from (for example) a deep vein thrombosis in the legs. In that setting, the risk of a new embolus (floating clot) at some point in the future is fairly high, even if you treat the patient with anti-coagulants (blood thinners). Closing the hole means the embolus goes to the lung instead of the brain (or kidney). That's not great either, but you have more reserve there. And it gives you more leeway in your anti-coagulant therapy, which may be needed if Mr. Sharon has other issues. |
| My educated guess: he's sicker than the press and goverment are letting on. He had a stroke and they think they have an explanation. They'll fix this, but he has underlying significant health problems. If I were an American government policy analyst, I'd start thinking, seriously and quietly, about life after Sharon. |