Patent Foramen Ovale Influences the Presentation of Decompression Illness in SCUBA Divers (original) (raw)
Related papers
Journal of Cardiology, 2019
Background: Patent foramen ovale (PFO), male sex, age, and body mass index (BMI) were all identified as potential risk factors of decompression sickness (DCS). It has been debated whether PFO might cause unprovoked DCS (i.e. without violation of decompression procedure) due to paradoxical embolization of venous gas emboli. To date, there are no data on the incidence or risk factors of unprovoked DCS. This study sought to evaluate the risk factors of unprovoked DCS in recreational divers. Methods: A total of 489 consecutive divers were screened for PFO between January 2006 and January 2014 by means of transcranial Doppler. All patients were prospectively included in the study registry. Survival analysis techniques were used to assess for risk factors for unprovoked DCS. Age, sex, BMI, PFO presence, and grade were analyzed. The total sum of dives was used as a measure of time. Results: The group performed a total of 169,411 dives (mean 346 AE 636). Thirty-six (7%) of the divers suffered from an unprovoked DCS. The frequency of PFO was 97.2% in divers with a history of unprovoked DCS and 35.5% in controls (p < 0.001). There was no difference in sex, age, BMI, or total number of dives between the respective groups. In the adjusted Cox proportional hazards model, PFO grade 3 was a major risk factor for unprovoked DCS; there was a slight protective effect of increasing age. Conclusions: We demonstrated that a high-grade PFO was a major risk factor for unprovoked DCS in recreational scuba divers.
The American Journal of Cardiology, 2004
Functional and anatomic characteristics of patent foramen ovale (PFO) were investigated in 66 professional scuba divers (41 with and 25 without decompression illness) using transthoracic and transesophageal echocardiography. PFO with right-to-left shunting at rest is associated with decompression illness, particularly the neurologic type. A wider patency diameter together with a higher membrane mobility are associated with the risk of developing the disease in divers with PFO. ᮊ2004 by Excerpta Medica, Inc.
Patent Foramen Ovale and Decompression Sickness in Divers
The Lancet, 1989
Germonpré , P., P. Dendale, P. Unger, and C. Balestra. Patent foramen ovale and decompression sickness in sports divers. J. Appl. Physiol. 84(5): 1622-1626, 1998.-Patency of the foramen ovale (PFO) may be a cause of unexplained decompression sickness (DCS) in sports divers. To assess the relationship between PFO and DCS, a case-control study was undertaken in a population of Belgian sports divers. Thirtyseven divers who suffered from neurological DCS were compared with matched control divers who never had DCS. All divers were investigated with transesophageal contrast echocardiography for the presence of PFO. PFO size was semiquantified on the basis of the amount of contrast passage. Divers with DCS with lesions localized in the high cervical spinal cord, cerebellum, inner ear organs, or cerebrum had a significantly higher prevalence of PFO than divers with DCS localizations in the lower spinal cord. For unexplained DCS (DCS without commission of any diving procedural errors), this difference was significant for large PFOs only. We conclude that PFO plays a significant role in the occurrence of unexplained cerebral DCS, but not of spinal DCS. We further stress the importance of standardization and semiquantification of future PFO studies that use transesophageal contrast echocardiography.
Patent foramen ovale and decompression sickness in sports divers
Journal of Applied Physiology
Germonpré , P., P. Dendale, P. Unger, and C. Balestra. Patent foramen ovale and decompression sickness in sports divers. J. Appl. Physiol. 84(5): 1622-1626, 1998.-Patency of the foramen ovale (PFO) may be a cause of unexplained decompression sickness (DCS) in sports divers. To assess the relationship between PFO and DCS, a case-control study was undertaken in a population of Belgian sports divers. Thirtyseven divers who suffered from neurological DCS were compared with matched control divers who never had DCS. All divers were investigated with transesophageal contrast echocardiography for the presence of PFO. PFO size was semiquantified on the basis of the amount of contrast passage. Divers with DCS with lesions localized in the high cervical spinal cord, cerebellum, inner ear organs, or cerebrum had a significantly higher prevalence of PFO than divers with DCS localizations in the lower spinal cord. For unexplained DCS (DCS without commission of any diving procedural errors), this difference was significant for large PFOs only. We conclude that PFO plays a significant role in the occurrence of unexplained cerebral DCS, but not of spinal DCS. We further stress the importance of standardization and semiquantification of future PFO studies that use transesophageal contrast echocardiography.
Yearbook of Sports Medicine
Using a standardized contrast-enhanced transesophageal echocardiographic technique, a group of divers was reexamined for the presence and size of patent foramen ovale (PFO) 7 years after their initial examinations. Unexpected but significant increases in the prevalence and size of PFO were found, suggesting a possible increasing risk for decompression sickness in these divers over time. ᮊ2005 by Excerpta Medica Inc.
Diving and Hyperbaric Medicine Journal, 2021
The case of a diver with a history of decompression sickness (DCS) after recreational scuba diving is presented. Cutis marmorata, a subtype of cutaneous DCS, has been consistently associated with the presence of a persistent (patent) foramen ovale (PFO) as a risk factor. Diagnostic uncertainty arose when transthoracic echocardiography with antecubital injection of agitated saline bubbles (ASBs) did not show any significant shunt, but the presence of a large Eustachian valve was counteracted by intra-femoral injection of ASBs, showing a large PFO with spontaneous shunting. The importance of proper echocardiography techniques prior to resorting to intra-femoral injection of ASBs to counteract the haemodynamic effects of the Eustachian valve is emphasised.
Canadian Journal of Cardiology, 2015
Patent foramen ovale (PFO) is associated with an increased risk of decompression sickness (DCS) in divers due to paradoxical embolization of nitrogen bubbles. The number of scuba divers worldwide is estimated in millions and the prevalence of PFO is 25-30% in adults. It is interesting that, despite these numbers, many important questions regarding optimal screening, risk stratification and management strategy still remain to be answered. Recently published data suggest the possible effectiveness of both PFO closure and conservative diving measures in preventing arterial gas embolization. This review aims to introduce the basic principles of physiology and the pathophysiology of bubble formation and DCS, summarize the current literature on PFO and diving and review the possibilities of diagnostic work-up and management.
The possible relationship between patent foramen ovale and decompression sickness
1999
A patent foramen ovale (PFO) is a small opening between the right and left cardiac atria, a persisting remnant of a physiologic communication present in the fetal heart. This normally closes after birth, but remains patent through to adulthood in up to a third of normal adults. A patent PFO is a potential conduit for blood clot (resulting in a stroke), or venous gas bubbles during decompression, (resulting in type II neurologic decompression sickness). There has been considerable controversy about the significance of a PFO as a possible mechanism for type II decompression sickness. Despite the high prevalence of PFO in the general population, and the relatively common occurrence of venous gas bubbles in diving and altitude exposures, the incidence of type II DCS in diving or with altitude exposure is low. This paper reviews the literature with respect to the potential for rightto-left embolization through a PFO, relation of PFO to DCS, screening techniques for PFO, and treatment options. The literature supports a relationship between the presence and size of PFO and cryptogenic stroke (stroke, generally in younger individuals with no other identifiable risk factors). The weight of evidence also favours an increased relative risk of type II DCS with a PFO, although the absolute increase in risk accrued is small. The gold standard for PFO screening is a trans-esophageal echocardiographic (TEE) and colour flow study, but trans-cranial Doppler (TCD) with contrast is a promising technique with good accuracy compared with TEE.
Diving physiopathology: the end of certainties? Food for thought
Minerva Anestesiologica
our understanding of decompression physiopathology has slowly improved during this last decade and some uncertainties have disappeared. a better understanding of anatomy and functional aspects of patent foramen ovale (PFo) have slowly resulted in a more liberal approach toward the medical fitness to dive for those bearing a PFO. Circulating vascular gas emboli (Vge) are considered the key actors in development of decompression sickness and can be considered as markers of decompression stress indicating induction of pathophysiological processes not necessarily leading to occurrence of disease symptoms. During the last decade, it has appeared possible to influence post-dive VGE by a so-called "preconditioning" as a pre-dive denitrogenation, exercise or some pharmacological agents. in the text we have deeply examined all the scientific evidence about this complicated but challenging theme. Finally, the role of the "normobaric oxygen paradox" has been clarified and it is not surprising that it could be involved in neuroprotection and cardioprotection. However, the best level of inspired oxygen and the exact time frame to achieve optimal effect is still not known. The aim of this paper was to reflect upon the most actual uncertainties and distil out of them a coherent, balanced advice towards the researchers involved in gas-bubbles-related pathologies.