“The nurses and the doctors were just unbelievable,” Herbst says. “I have nothing but positive things to say about the experience I had in the hospital, the ER, and the ICU. And Dr. Edris is wonderful. I was in good hands.”
In the Emergency department, doctors believed early on that they knew the source of the blood clot: Herbst and his wife had a nonstop, 11-hour flight home from Spain the day before. Blood clots sometimes develop in legs during air travel because people are immobile for long periods.
Normally, if a clot in the leg breaks loose, it travels to the right side of the heart and then into the lungs, causing a pulmonary embolism. To get to the brain, Edris explains, the clot would have to take a route that doesn’t usually exist, crossing through an opening between the right and left upper chambers of the heart. That pointed to a patent foramen ovale (PFO) in Herbst’s heart — the door between the upper chambers that never closed.
In a fetus, that door allows oxygen-rich blood to bypass the lungs, which aren’t yet functioning. After a baby begins to breathe, blood flows to the lungs and the door usually closes — or at least it does for about three-quarters of the population.
Though 25 percent of people have a PFO, strokes like Herbst’s are rare. They are even rarer at his age, 70. Most often, strokes are related to high blood pressure, obesity, lack of physical activity, smoking, or other risk factors.
But Herbst didn’t fit the profile. He runs, plays tennis, and golfs. He eats well, doesn’t smoke or drink, and says a recent physical had found “my blood was good, my heart was good.”
Edris says PFO-related strokes are often a “diagnosis of exclusion because we have to make sure we’re not missing anything else that could have caused the stroke. Our multidisciplinary team did an extensive work-up for the cause of the stroke, looking for diabetes, [high] cholesterol, clotting disorders, heart-rhythm disturbances. He didn’t have any of this.”
But they did find a hole in his heart. Edris, Director of Interventional Cardiology and Structural Heart Disease, closed the hole by implanting a small, round, wire mesh device called an Amplatzer PFO Occluder.
The procedure took place in a state-of-the-art hybrid operating room (OR) at Community Hospital, one of two opened in 2023. The hybrid ORs combine the features of a surgical suite with advanced imaging technology that is key to guiding minimally invasive procedures like the one performed by Edris, who placed the device using a catheter inserted through a small incision.
Herbst is grateful for his care, delivered so close to his Monterey home.
“They did it in 40 minutes,” he says. “Back in the recovery room, I had no pain, and I was able to walk.”
And he is returning to Spain — this time with precautions to prevent blood clots, including taking blood thinners and wearing compression socks.
“I’m very lucky,” he says.
