Relation between Directly Detected Patent Foramen Ovale and Ischemic Brain Lesions in Sport Divers (original) (raw)
Related papers
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.
Heart, 2011
Objective To test the effect of patent foramen ovale (PFO) closure on neurological events in divers. Design Prospective, non-randomised, longitudinal threearm study. Setting Tertiary referral centre. Population 104 scuba divers with a history of major decompression illness (DCI). Intervention Transcutaneous PFO closure. Main outcome measures Baseline and three follow-up examinations with a questionnaire about health status and diving habits/accidents, transoesophageal echocardiography at baseline for PFO grading, cerebral MRI at all examinations.
Patent foramen ovale in scuba divers. A report of two cases and a brief review of the literature
Italian heart journal: official journal of the Italian Federation of Cardiology
Scuba diving (diving with a self-contained underwater breathing apparatus) has become a popular sport. Decompression illness may be due to the formation of gas bubbles in various body tissues at an increased ambient pressure. The gas can pass from the systemic venous circulation into the arterial circulation as a result of either pulmonary barotrauma or intravascular shunting. Gas emboli may be the cause of an increased prevalence of brain lesions in sport divers.
Diving and hyperbaric medicine, 2015
This consensus statement is the result of a workshop at the SPUMS Annual Scientific Meeting 2014 with representatives of the UK Sports Diving Medical Committee (UKSDMC) present, and subsequent discussions including the entire UKSDMC. Right-to-left shunt across a persistent or patent foramen ovale (PFO) is a risk factor for some types of decompression illness. It was agreed that routine screening for PFO is not currently justifiable, but certain high risk sub-groups can be identified. Divers with a history of cerebral, spinal, inner-ear or cutaneous decompression illness, migraine with aura, a family history of PFO or atrial septal defect and those with other forms of congenital heart disease are considered to be at higher risk. For these individuals, screening should be considered. If screening is undertaken it should be by bubble contrast transthoracic echocardiography with provocative manoeuvres, including Valsalva release and sniffing. Appropriate quality control is important. If a s...
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.
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.
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.
Frontiers in Psychology, 2016
SCUBA diving exposes divers to decompression sickness (DCS). There has been considerable debate whether divers with a Patent Foramen Ovale of the heart have a higher risk of DCS because of the possible right-to-left shunt of venous decompression bubbles into the arterial circulation. Symptomatic neurological DCS has been shown to cause permanent damage to brain and spinal cord tissue; it has been suggested that divers with PFO may be at higher risk of developing subclinical brain lesions because of repeated asymptomatic embolization of decompression-induced nitrogen bubbles. These studies however suffer from several methodological flaws, including self-selection bias. We recruited 200 volunteer divers from a recreational diving population who had never suffered from DCS; we then randomly selected 50 of those for further investigation. The selected divers underwent brain Magnetic Resonance Imaging to detect asymptomatic brain lesions, contrast trans-oesophageal echocardiography for PFO, and extensive neuro-psychometric testing. Neuro-psychometry results were compared with a control group of normal subjects and a separate control group for subjects exposed to neurotoxic solvents. Forty two divers underwent all the tests and are included in this report. Grade 2 Patent Foramen Ovale was found in 16 (38%) of the divers; brain Unidentified Bright Objects (UBO's) were found in 5 (11.9%). There was no association between PFO and the presence of UBO's (P = 0.693) or their size (p = 0.5) in divers. Neuropsychometric testing in divers was significantly worse from controls in two tests, Digit Span Backwards (DSB; p < 0.05) and Symbol-Digit-Substitution (SDS; p < 0.01). Compared to subjects exposed to neurotoxic solvents, divers scored similar on DSB and SDS tests, but significantly better on the Simple Reaction Time (REA) and Hand-Eye Coordination (EYE) tests. There was no correlation between PFO, number of UBO's and any of the neuro-psychometric tests. We conclude that for uneventful recreational diving, PFO does not appear to influence the presence of UBO's. Diving by itself seems to cause some decrease of short-term memory and higher cognitive function, including visual-motor skills; this resembles some of the effects of nitrogen narcosis and we suggest that this may be a prolonged effect of diving.
Evidence for increasing patency of the foramen ovale in divers
The American Journal of Cardiology, 2005
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.