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

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

doi:10.1016/j.jjcc.2019.04.014

Cited by 17 publications

(17 citation statements)

References 20 publications

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“…In a previous report from the DIVE-PFO, we have demonstrated that a high-grade PFO was a major risk factor for unprovoked DCS in 489 recreational scuba divers (22). This study specifi cally focused on recreational diving only and 7 % of the divers suffered from an unprovoked DCS.…”

Section: Discussionmentioning

confidence: 86%

Risk stratification of neurological decompression sickness in divers

Sramek¹,

Honek²,

Tomek³

et al. 2022

BLL

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INTRODUCTION: Patent foramen ovale (PFO) is a risk factor of decompression sickness (DCS). However, data on risk stratifi cation of divers with a PFO are sparse. This study sought to evaluate the risk of neurological DCS (DCSneuro), based on the presence and grade of a right-to-left shunt (RLS). METHODS: A total of 640 divers were screened for a RLS using TCD between 1/2006 and 4/2017. RLS was graded as low, medium, or high grade with two subgroups -after a Valsalva maneuver or at rest. Divers were questioned about their DCS history. Survival analysis techniques were used to assess risk factors for unprovoked DCS. RESULTS: A RLS was found in 258 divers (40.3 %). 44 (17.1 %) divers with a RLS experienced DCSneuro compared to 5 (1.3 %) divers without a RLS (p < 0.001). The proportion of DCSneuro increased from 4.6 % in the low-grade RLS subgroup to 57.1 % in the subgroup with high-grade RLS at rest. The hazard ratio for DCSneuro and RLS was11.806 (p < 0.001). CONCLUSIONS: Divers with a RLS had a higher risk of DCSneuro and the risk increased with RLS grade. We suggest that TCD is an appropriate method for RLS screening and risk stratifi cation in divers (Tab. 4, Fig. 2, Ref. 29).

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Section: Discussionmentioning

confidence: 86%

Risk stratification of neurological decompression sickness in divers

Sramek¹,

Honek²,

Tomek³

et al. 2022

BLL

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“…In brief, on the one hand, it has traditionally been considered that DCS with cerebral involvement would be due to the predominant involvement of the arterial circulation (stroke-like radiological imaging) [ 5 , 9 ], by paradoxical embolism in patients with patent foramen ovale (PFO) or by opening of pulmonary arterio-venous shunts in the case of large venous embolisms where the alveolar–capillary filter is exceeded [ 5 , 8 ]. Thus, previous studies have shown that the presence of a right-to-left shunt, as in the case of a PFO, significantly increases the risk of DCS in compressed-gas diving by facilitating a paradoxical pathway of arterial embolism [ 10 , 11 , 12 , 13 ]. This facilitating effect of the development of DCS, related to the right-to-left shunt, has also been suggested in some cases in breath-hold divers [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Breath-Hold Diving-Related Decompression Sickness with Brain Involvement: From Neuroimaging to Pathophysiology

et al. 2022

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Central nervous system involvement related to decompression sickness (DCS) is a very rare complication of breath-hold diving. So far, it has been postulated that repeated dives with short surface intervals represent a key factor in the development of breath-holding-related DCS. We report the case of a breath-hold diver who, after repeated immersion, developed DCS with brain involvement. After treatment in a hyperbaric chamber, there was a clinical improvement in the symptoms. Magnetic resonance imaging of the brain showed hyperintense lesions in long-time repetition sequences (FLAIR, T2WI) in the left frontal and right temporal lobes. Diffusion-weighted imaging (DWI) sequences and the apparent diffusion coefficient (ADC) map were characteristic of vasogenic edema, allowing us to exclude the ischemic nature of the process. These findings, together with the acute clinical presentation, the resolution of lesions in evolutionary radiological controls and the possible involvement of blood–brain barrier/endothelial dysfunction in DCS, could suggest a new form of posterior reversible encephalopathy syndrome (PRES)-like presentation of DCS. This would represent a novel mechanism to explain the pathophysiology of this entity. We conducted a literature review, analyzing the pathophysiological and neuroimaging characteristics of DCS in breath-hold diving based on a case of this rare disease.

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“…The presence of PFO grade 3 was significantly associated with unprovoked DCS episode in professional SCUBA divers. 27 …”

Section: Pfo Presence and The Risk For DCImentioning

confidence: 99%

The management of patent foramen ovale in divers: where do we stand?

Toutouzas

Drakopoulou

Trantalis

et al. 2022

Ther Adv Neurol Disord

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Diving is a fascinating activity, but it does not come without any cost; decompression illness (DCI) is one of the most frequent diseases occurring in divers. Rapid surfacing after diving causes alveolar rupture and bubbles release, which enter in the systemic circulation and could embolize numerous organs and tissues. The presence of patent foramen ovale (PFO) contributes to the passage of venous gas bubbles into the arterial circulation, increasing the risk of complications related to DCI. The diagnosis is established with a detailed medical history, a comprehensive clinical evaluation, and a multimodal imaging approach. Although the percutaneous closure of PFO is ambiguous for divers, as a primary prevention strategy, transcatheter management is considered as beneficial for DCI recurrence prevention. The aim of this study is to introduce the basic principles of DCI, to review the pathophysiological connection between DCI and PFO, to highlight the risk factors and the optimal treatment, and, last but not least, to shed light on the role of closure as primary and secondary prevention.

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

Cited by 17 publications

References 20 publications

Risk stratification of neurological decompression sickness in divers

Risk stratification of neurological decompression sickness in divers

Breath-Hold Diving-Related Decompression Sickness with Brain Involvement: From Neuroimaging to Pathophysiology

The management of patent foramen ovale in divers: where do we stand?

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