Effect of conservative dive profiles on the occurrence of venous and arterial bubbles in divers with a patent foramen ovale: A pilot study

Honěk, Jakub; Šrámek, Martin; Šefc, Luděk; Januška, Jaroslav; Fiedler, Jiří; Horváth, Martin; Tomek, Aleš; Novotný, Š; Honĕk, T; Veselka, Josef

doi:10.1016/j.ijcard.2014.04.218

Cited by 16 publications

(16 citation statements)

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“…In addition, after PFO closure, DCS was not observed in any of the divers. In another study, a conservative dive profile with a short exposure and a slower ascent rate decreased the occurrence of both venous and arterial gas emboli [30]. Both studies suggest that gas bubbles embolize through the PFO in divers and might be responsible for a higher risk of DCS.…”

Section: Discussionmentioning

confidence: 92%

High-grade patent foramen ovale is a risk factor of unprovoked decompression sickness in recreational divers

Honěk

Šrámek

Šefc

et al. 2019

Journal of Cardiology

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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.

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Section: Discussionmentioning

confidence: 92%

High-grade patent foramen ovale is a risk factor of unprovoked decompression sickness in recreational divers

Honěk

Šrámek

Šefc

et al. 2019

Journal of Cardiology

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“…First, there is the legitimate question of either the effectiveness of preventive measures, or the implementation of these measures when resuming diving after an accident. On one hand, studies that have evaluated procedures to reduce nitrogen load after a first episode of DCS appeared to reduce the probability for subsequent DCS (Klingmann et al, 2012 ; Honek et al, 2014a , b ). On the other hand, it has to be noted that subgroup analysis shows that multiple time injured divers dived significantly more than the average diver with 70 ± 38 dives/year and 74 ± 33 dives/year for 2nd DCS and 3rd DCS group, respectively.…”

Section: Discussionmentioning

confidence: 99%

Patent Foramen Ovale (PFO), Personality Traits, and Iterative Decompression Sickness. Retrospective Analysis of 209 Cases

et al. 2017

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Introduction: There is a need to evaluate the influence of risk factors such as patency of foramen ovale (PFO) or “daredevil” psychological profile on contra-indication policy after a decompression sickness (DCS).Methods: By crossing information obtained from Belgian Hyperbaric Centers, DAN Emergency Hotline, the press, and Internet diving forums, it was possible to be accountable for the majority if not all DCS, which have occurred in Belgium from January 1993 to June 2013. From the available 594 records we excluded all cases with tentative diagnosis, medullary DCS or unreliability of reported dive profile, leaving 209 divers records with cerebral DCS for analysis. Demographics, dive parameters, and PFO grading were recorded. Twenty-three injured divers were tested using the Zuckerman's Sensation Seeking Scale V and compared to a matched group not involved in risky activities.Results: 41.2% of all injured came for iterative DCS. The average depth significantly increases with previous occurrences of DCS (1st DCS: 31.8 ± 7.9 mfw; 2nd DCS: 35.5 ± 9.8 mfw; 3rd DCS: 43.4 ± 6.1 mfw). There is also an increase of PFO prevalence among multiple injured divers (1st DCS: 66.4% 2nd & 3rd DCS: 100%) with a significant increase in PFO grade. Multiple-times injured significantly scored higher than control group on thrill and adventure seeking (TAS), experience seeking, boredom susceptibility and total score.Conclusion: There is an inability of injured diver to adopt conservative dive profile after a DCS. Further work is needed to ascertain whether selected personality characteristics or PFO should be taken into account in the clearance decision to resume diving.

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“…Moreover, limited observational evidence in divers is available and no data are available for aircrews. However, on any occasion, inhibiting the production of VGE has the potential to prevent further DCS, irrespective of the presence of a PFO 28,29 . This can be achieved by: a) modifying the individual's lifestyle and personal physiologic characteristics (smoking and alcohol consumption, body weight, ensuring adequate hydration pre and post dive); b) avoiding those technical dive or flight factors that have caused abnormal VGE production; and c) reducing the inert gas saturation of tissues before decompression by breathing high concentrations of oxygen before the ascent (Supplementary Table 4).…”

Section: Secondary Preventionmentioning

confidence: 99%

European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

Pristipino¹,

Germonpré²,

Toni³

et al. 2021

EuroIntervention

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Effect of conservative dive profiles on the occurrence of venous and arterial bubbles in divers with a patent foramen ovale: A pilot study

Cited by 16 publications

References 4 publications

High-grade patent foramen ovale is a risk factor of unprovoked decompression sickness in recreational divers

High-grade patent foramen ovale is a risk factor of unprovoked decompression sickness in recreational divers

Patent Foramen Ovale (PFO), Personality Traits, and Iterative Decompression Sickness. Retrospective Analysis of 209 Cases

European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

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