- Umbrella procedure aimed at people with obstructive sleep apnoea (OPA)
- OPA is linked to heart defect which causes a hole failing to close at birth
- Operation uses a catheter which is guided through blood vessels to heart
- Umbrellas are opened either side of hole and clamped together to cover it
Roger Dobson for The Mail on Sunday
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A tiny umbrella that repairs a hole in the heart could save chronic snorers from the risk of cardiac arrest and stroke (file photo)
A tiny umbrella that repairs a hole in the heart could save chronic snorers from the risk of cardiac arrest and stroke.
The procedure is aimed at people with obstructive sleep apnoea (OSA), where the soft tissue in the throat collapses during sleep and leads to snoring.
This condition has been linked to a congenital heart defect called a patent foramen ovale (PFO) – a hole that has failed to close at birth.
By using a new procedure to close the hole, employing a device shaped like two small umbrellas, British doctors have found that they can improve the side effects of sleep apnoea and lower the sufferer’s risk of cardiac arrest.
In OSA, the collapse of the soft tissues of the upper airways can result in no airflow for several seconds, which in turn can lead to lower levels of oxygen in the blood.
The condition is associated with an elevated risk of cardiac arrest and high blood pressure, with OSA sufferers three time more likely to have heart disease or a stroke.
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It is estimated that four per cent of middle-aged men and two per cent of women have OSA, and it is more common among the elderly, the overweight and smokers.
Research has shown that 70 per cent of people who suffer sleep apnoea also have a congenital hole in the heart.
A foramen ovale is a small hole located in the septum or wall between the two upper chambers of the heart in a growing foetus, which does not use its lungs. It allows oxygen-rich blood to travel from the veins to the right side of the baby’s heart and across to the left side of the heart.
Normally, increased blood pressure on the left side of the heart at birth forces the opening to close. But in some people – 20 to 30 per cent – it does not and is known as a PFO.
Pictured: How the new procedure, aimed at people suffering from obstructive sleep apnoea, is carried out
This works like a flap valve, opening during certain conditions when there is more pressure inside the chest, such as when coughing, sneezing or snoring.
It means that blood can travel from the right chamber of the heart to the left, bypassing the filtering of the lungs.
Debris and clots in the blood normally screened out by the lungs may escape through the hole and travel out of the heart and to the brain, increasing the risk of stroke, or into a coronary artery, triggering a heart attack.
In patients with OSA, when the PFO opens during an apnoea – an interruption of the airflow – it allows unoxygenated blood through to mix with oxygenated blood from the lungs, causing oxygen desaturation – low levels of oxygen in the blood.
The new umbrella operation, carried out at Papworth Hospital in Cambridge, is offered to people with PFO and OSA with high levels of oxygen desaturation.
The device consists of a number of wire-like struts in an umbrella shape which support two discs of soft material.
The wires and discs are attached to a small platinum wire or rod. The device is loaded into a catheter or tube with the wires folded like an unopened umbrella.
The procedure is being carried out at Papworth Hospital (pictured) in Cambridge and doctors say that initial case reports suggest the treatment can be ‘effective’
The catheter is inserted into a vein in the patient’s groin and is navigated through the blood vessels to the site of the PFO in the heart. Once at the hole, the device goes partly through the hole and the first umbrella is opened. The second is opened on the other side.
With the two umbrellas open on either side of the hole, they are pulled together with tightening wires to clamp the tissue between them and cover the hole.
Over time, tissue grows over the device and it becomes incorporated into the body, completely sealing the hole.
‘Individual case reports have suggested it can be effective,’ says Dr Stephen Hoole, consultant interventional cardiologist at Papworth who has carried out this procedure on patients with OSA.
‘Ultimately, our hope is to reduce the incidence of fatal and non-fatal cardiovascular events in susceptible individuals with OSA.
‘However, we are treating 30 patients initially, and while patients have anecdotally reported improvements, we have yet to fully analyse the data to determine the impact of this treatment on OSA.’
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