Risk mitigation in divers with persistent (patent) foramen ovale

Wilmshurst, Peter

doi:10.28920/dhm49.2.77-78

Cited by 16 publications

(17 citation statements)

References 5 publications

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“…We therefore confirm the need for comprehensive evaluation and expert counseling of each diver presenting with DCS and PFO and seeking advice whether this PFO should be closed (Germonpre, 2015;Smart et al, 2015;Wilmshurst, 2019). Any recommendation on "conservative diving" should be given according to internationally published "low-bubble" guidelines, not simply relying on the dive computer to make "nodecompression dives."…”

Section: Data Availability Statementmentioning

confidence: 52%

“…In other studies it was also reported that even though the PFO was closed, a significant number of divers adopted a more conservative diving attitude (Koopsen et al, 2018;Anderson et al, 2019;Vanden Eede et al, 2019). A recent report (Anderson et al, 2019) described a better reduction of DCS incidence after PFO closure compared to "conservative diving, " but major methodological flaws have been pointed out by an accompanying editorial (Wilmshurst, 2019).…”

Section: Strengthsmentioning

confidence: 99%

“…Lastly, the diagnostic accuracy of PFO detection is highly dependent on the technology and technique used for PFO detection (Gin et al, 1993;Wilmshurst et al, 2003;Attaran et al, 2006;Johansson et al, 2010). Unless all these factors can be accounted for, estimates of increased DCS risk remain highly speculative (Vann et al, 2008;Wilmshurst, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Increased Risk of Decompression Sickness When Diving With a Right-to-Left Shunt: Results of a Prospective Single-Blinded Observational Study (The “Carotid Doppler” Study)

Germonpré¹,

Lafère²,

Portier³

et al. 2021

Front. Physiol.

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Introduction: Divers with a patent Foramen Ovale (PFO) have an increased risk for decompression sickness (DCS) when diving with compressed breathing gas. The relative risk increase, however, is difficult to establish as the PFO status of divers is usually only determined after a DCS occurrence.Methods: This prospective, single-blinded, observational study was designed to collect DCS data from volunteer divers after screening for right-to-left shunt (RLS) using a Carotid Doppler test. Divers were blinded to the result of the test, but all received a standardized briefing on current scientific knowledge of diving physiology and “low-bubble” diving techniques; they were then allowed to dive without restrictions. After a mean interval of 8 years, a questionnaire was sent collecting data on their dives and cases of DCS (if any occurred).Results: Data was collected on 148 divers totaling 66,859 dives. There was no significant difference in diving data between divers with or without RLS. Divers with RLS had a 3.02 times higher incidence of (confirmed) DCS than divers without RLS (p = 0.04). When all cases of (confirmed or possible DCS) were considered, the Relative Risk was 1.42 (p = 0.46). DCS occurred mainly in divers who did not dive according to “low-bubble” diving techniques, in both groups.Conclusion: This prospective study confirms that DCS is more frequent in divers with RLS (such as a PFO), with a Relative Risk of 1.42 (all DCS) to 3.02 (confirmed DCS). It appears this risk is linked to diving behavior, more specifically diving to the limits of the adopted decompression procedures.

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Section: Data Availability Statementmentioning

confidence: 52%

Section: Strengthsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Increased Risk of Decompression Sickness When Diving With a Right-to-Left Shunt: Results of a Prospective Single-Blinded Observational Study (The “Carotid Doppler” Study)

Germonpré¹,

Lafère²,

Portier³

et al. 2021

Front. Physiol.

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“…Therefore, patients must be counseled regarding the possibility of a residual shunt during preprocedure evaluation. [ 44 45 ] Currently, there are no available pediatric data guiding the management of PFO in young scuba divers.…”

Section: Patent Foramen Ovale-associated Clinical Scenariosmentioning

confidence: 99%

Patent foramen ovale in children: Unique pediatric challenges and lessons learned from adult literature

et al. 2022

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“…The percutaneous closure of PFO, however, remains the most effective strategy in patients who have already experienced DCS and want to fully continue the immersive activity [12,45,49,53]. After PFO closure, the risk of DCS is comparable to that of the normal population, while the risk of AGE is unaffected [54]. The choice of PFO percutaneous closure must take into account the risk-benefit ratio of the procedure, with complications such as cardiac tamponade (0.4-0.7%), device embolization (0.7%), and bleeding (0.4%).…”

Section: Diving With Pfomentioning

confidence: 99%

Patent Foramen Ovale—A Not So Innocuous Septal Atrial Defect in Adults

Romano

Gallinoro

Mottola

et al. 2021

JCDD

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Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15%–35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.

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Risk mitigation in divers with persistent (patent) foramen ovale

Cited by 16 publications

References 5 publications

Increased Risk of Decompression Sickness When Diving With a Right-to-Left Shunt: Results of a Prospective Single-Blinded Observational Study (The “Carotid Doppler” Study)

Increased Risk of Decompression Sickness When Diving With a Right-to-Left Shunt: Results of a Prospective Single-Blinded Observational Study (The “Carotid Doppler” Study)

Patent foramen ovale in children: Unique pediatric challenges and lessons learned from adult literature

Patent Foramen Ovale—A Not So Innocuous Septal Atrial Defect in Adults

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