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A second appendix? Removing it may cut the risk of stroke

appendix removal
Heart surgeons remove an appendix that may increase the risk of stroke  
October 19, 1998
Web posted at: 1:16 p.m. EDT (1716 GMT)

From Medical Correspondent Dan Rutz

MILWAUKEE (CNN) -- A small appendix attached to the heart in all humans may increase the risk for stroke. It is this danger that is prompting a pioneer heart surgeon to remove the appendage during heart surgery.

Coronary bypass operation is one of the most common operations in the United States. But Dr. Dudley Johnson of St. Francis Hospital in Milwaukee, adds a new twist by also snipping away the left atrial appendage.

Like the intestinal appendix, the heart appendage appears to serve no useful function in the body.

Trouble starts if the upper chamber of the heart ever starts quivering, a common condition called atrial fibrillation.

"The stroke rate in these people is at least five times higher than in the general population of others of similar age," Johnson said.

Mayo Clinic researchers report than in nine out of 10 patients with atrial fibrillation, blood clots form in that little appendage. If the clots get big enough or break free, they can block off blood flow to the brain and cause a stroke.

Johnson said it is easy enough to prevent.

"It will take us two or three minutes to remove this appendage," he said. "If and when this patient ever goes into atrial fibrillation, we have now eliminated the major cause of death from atrial fibrillation."

An American Heart Association spokesman applauds Johnson's vision, but adds that since there is not proof that the idea actually translates into few strokes, most doctors shy away from clipping the appendage.

The Food and Drug Administration recently approved Johnson's next plan to do the appendage removal as a separate operation for patients who don't need a coronary bypass.

St. Francis Hospital has agreed to cover the costs on the first 10 cases.

The operation is much less involved than bypass. For now, it's being offered to those with established irregular heartbeats who can't tolerate the usual medications.

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