Paradoxical gas embolism in a scuba diver with an atrial septal defect.

Wilmshurst, Peter; Ellis, B.G.; Jenkins, B S

doi:10.1136/bmj.293.6557.1277

Cited by 69 publications

(34 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In 1986, Wilmshurst and associates (11) suggested that atrial septal defect and patent foramen ovale may be relevant to paradoxical gas embolism among scuba divers (11). Subsequent studies did not include a control group, cerebral neuroimaging, or transesophageal echocardiography for diagnosis of patent foramen ovale.…”

Section: Discussionmentioning

confidence: 99%

Relation between Directly Detected Patent Foramen Ovale and Ischemic Brain Lesions in Sport Divers

et al. 2001

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Relation between Directly Detected Patent Foramen Ovale and Ischemic Brain Lesions in Sport Divers

et al. 2001

View full text Add to dashboard Cite

“…4 In subsequent studies, the importance of PFO for decompression events has been further observed by investigating its presence among divers with and without a history of previous DCI events (up to 66% in the former versus 25-33% in the latter). 5-7;9;10 These studies have major limitations however by being, in the majority too small and in one case exclusively including divers without DCI, 10 by not taking into account the numbers of dives or having been published only in a preliminary form.…”

Section: Decompression Illness Events: Data From the Literaturementioning

confidence: 99%

“…4 Subsequently, the importance of PFO for decompression events in divers has been further investigated. [5][6][7] However, the risk of developing DCI when a diver has a PFO has not been directly and accurately determined so far, but only crudely estimated on the basis of a meta-analysis 8 incorporating three partly small studies which, in addition, have employed transthoracic instead of the more sensitive trans-oesophageal echocardiography (TEE) for detecting PFO.…”

Section: Introductionmentioning

confidence: 99%

Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale

Torti¹,

Billinger²,

Schwerzmann³

2004

ACC Current Journal Review

View full text Add to dashboard Cite

Background The risk of developing decompression illness (DCI) in divers with a patent foramen ovale (PFO) has not been directly determined so far; neither has it been assessed in relation to the PFO's size. Methods In 230 scuba divers (age 39 ± 8 years), contrast trans-oesophageal echocardiography (TEE) was performed for the detection and size grading (0-3) of PFO. Prior to TEE, the study individuals answered a detailed questionnaire about their health status and about their diving habits and accidents. For inclusion into the study, P200 dives and strict adherence to decompression tables were required. Results Sixty-three divers (27%) had a PFO. Overall, the absolute risk of suffering a DCI event was 2.5 per 10 4 dives. There were 18 divers (29%) with, and 10 divers (6%) without, PFO who had experienced P1 major DCI events ðP ¼ 0:016Þ. In the group with PFO, the incidence per 10 4 dives of a major DCI, a DCI lasting longer than 24 h and of being treated in a decompression chamber amounted to 5.1 (median 0, interquartile range [IQR] 0-10.0), 1.9 (median 0, IQR 0-4.0) and 3.6 (median 0, IQR 0-9.8), respectively and was 4.8-12.9-fold higher than in the group without PFO ðP < 0:001Þ. The risk of suffering a major DCI, of a DCI lasting longer than 24 h and of being treated by recompression increased with rising PFO size. Conclusion The presence of a PFO is related to a low absolute risk of suffering five major DCI events per 10 4 dives, the odds of which is five times as high as in divers without PFO. The risk of suffering a major DCI parallels PFO size.

show abstract

“…An atrial septal aneurysm (ASA), a saccular deformity of the atrial septum that protrudes 15 mm in the direction of either atria, is associated with 15% of PFOs and is often seen with the largest size PFO [3] and [4].…”

Section: Embryology and Anatomymentioning

confidence: 99%

Patent foramen ovale: Unanswered questions

Mojadidi

Christia

Salamon

et al. 2015

European Journal of Internal Medicine

View full text Add to dashboard Cite

The foramen ovale is a remnant of the fetal circulation that remains patent in 20-25% of the adult population. Although long overlooked as a potential pathway that could produce pathologic conditions, the presence of a patent foramen ovale (PFO) has been associated with a higher than expected frequency in a variety of clinical syndromes including cryptogenic stroke, migraines, sleep apnea, platypnea-orthodeoxia, deep sea diving associated decompression illness, and high altitude pulmonary edema. A unifying hypothesis is that a chemical or particulate matter from the venous circulation crosses the PFO conduit between the right and left atria to produce a variety of clinical syndromes. Although observational studies suggest a therapeutic benefit of PFO closure compared to medical therapy alone in patients with cryptogenic stroke, 3 randomized controlled trials (RCTs) did not confirm the superiority of PFO closure for the secondary prevention of stroke. However, meta-analyses of these RCTs demonstrate a significant benefit of PFO closure over medical therapy alone. Similarly, observational studies provide support for PFO closure for symptomatic relief of migraines. But one controversial randomized study failed to replicate the results of the observational studies while another two demonstrated a partial benefit. The goal of this review is to discuss the clinical conditions associated with PFO and provide internists and primary care physicians with current data on PFO trials, and clinical insight to help guide their patients who are found to have a PFO on echocardiographic testing. Embryology and anatomySince fetal lungs in utero are incapable of oxygenating blood, the fetus is dependent on the maternal circulation for oxygen delivery via the placenta. Oxygenated blood returning to the right atrium via the umbilical vein needs to be delivered to the brain and vital organs before further loss of oxygen occurs. To facilitate this rapid transit, an inter-atrial communication evolved in all mammals, known as the foramen ovale [1].After birth, the foramen ovale flap (the septum primum) physiologically closes against the septum secundum when pulmonary vascular resistance and right atrial pressure decrease. An atrial septal aneurysm (ASA), a saccular deformity of the atrial septum that protrudes 15 mm in the direction of either atria, is associated with 15% of PFOs and is often seen with the largest size PFO [3] and [4]. PFO imagingThe most accurate test for determining the presence of a PFO is a right heart catheterization with documentation of a guidewire crossing the atrial septum. The standard non-invasive method for diagnosing a PFO is transesophageal echocardiography (TEE) using agitated saline contrast [5]. Transcranial Doppler (TCD) is a more sensitive and less uncomfortable method for diagnosing PFO with a sensitivity of 97% and specificity of 93% [6]. Transthoracic echocardiogram (TTE) with bubble study is a less expensive, non-invasive test compared to TEE with comparable specificity [7] and [8]. Howeve...

show abstract

Paradoxical gas embolism in a scuba diver with an atrial septal defect.

Cited by 69 publications

References 1 publication

Relation between Directly Detected Patent Foramen Ovale and Ischemic Brain Lesions in Sport Divers

Relation between Directly Detected Patent Foramen Ovale and Ischemic Brain Lesions in Sport Divers

Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale

Patent foramen ovale: Unanswered questions

Contact Info

Product

Resources

About