On Sunday, the Schoonover family shared that Patrick's death was due to a heart defect. 

Patrick was born with several, likely related, cardiac abnormalities that affected his aortic valve and aorta. His aortic valve had only 2 leaflets as opposed to the normal three leaflets and is called a bicuspid aortic valve. This is a common cardiac abnormality that can frequently develop into a valve that becomes very narrowed (aortic stenosis) or a valve that becomes very leaky (aortic regurgitation) that often requires surgery later on in life to repair. The bicuspid aortic valve is also very often associated with an enlargement of the aorta, which is the largest artery in the body. In addition, Patrick was born with a "kink" or narrowing in the aorta called "coarctation" that usually is located just after the take-off of the artery branch that goes to the left arm (subclavian artery). The combination of the abnormal aortic valve and coarctation of the aorta is associated with a progressive enlargement of the ascending aorta after it leaves the heart. If the aorta becomes too large (aneurysm) it can rupture, and unfortunately that is what happened to Patrick. It is almost always a fatal event due to the large leakage of blood into the chest and sac (pericardium) that surrounds the heart called cardiac tamponade. The heart cannot function properly when its sac is full of blood. It was not related to Patrick's hockey even though it occurred on the ice.

The important question that parents may be asking is can this be detected. The answer is many times this condition can be detected on physical exam but it depends on the severity. The abnormal aortic valve will often make certain sounds and murmurs that can be heard with a stethoscope that leads to the patient getting an ultrasound (echocardiogram) of his heart. The coarctation can often be detected by the finding of a much weaker pulse or blood pressure in the legs compared to the arms. Patients may complain of abnormal fatigue or pain in their lower extremities with exercise. The aneurysm that ruptured cannot usually be detected on exam, but can be sometimes seen on a chest x-ray and always by a CT scan or MRI of the chest. There is often no symptoms with the aneurysm until it begins to rupture where it may be associated with chest pain.

Jay Traverse, MD
Director of Research
Minneapolis Heart Institute at Abbott Northwestern Hospital
Associate Professor of Medicine
Cardiovascular Division
University of Minnesota Medical School