Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2014, 23(3):223-227

Patent foramen ovale: transcatheter closure or conservative dive profile in decompression sickness prevention in divers?

Novotný Š1, 2, Honěk J3, 5, Januška J4, Šefc L5, Horváth M3, Fiedler J3, Šrámek M5, 6, Veselka J3, Honěk T3, Tatár M2
1 Hyperbarická komora a poradna pro potápěče, Kladno, Česká Republika
2 Ústav fyziologie a patologické fyziologie, Jeseniova lékařská fakulta UK, Martin, Slovenská republika
3 Kardiologická Klinika, FN Motol, LF UK, Praha, Česká republika
4 Nemocnice Podlesí a.s., Třinec; Česká republika
5 Ústav patologické fyziologie 1. lékařské fakulta UK, Praha, Česká republika
6 Neurologická Klinika, FN Motol, LF UK, Praha, Česká republika

Aim: The aim of this study was to compare the influence of transcatheter patent foramen ovale (PFO) closure and safe diving recommendations limiting bottom time and depth on the occurrence of arterial bubbles after simulated dives in a hyperbaric chamber.

Methods: Forty-seven divers with a PFO were enrolled in this observational trial. Nineteen divers with PFO performed a decompression dive to 18m for 80 min (control group), 15 divers after a transcatheter PFO closure performed the same dive (group 1) and 13 divers with PFO performed a dive to the same depth for a non-decompression time of 51 min (group 2). In all divers venous and arterial bubbles were screened, venous bubbles by means of transthoracic echocardiography, arterial by means of transcranial Doppler ultrasonography.

Results: Venous bubbles were detected in 74% divers in the control group, in 80% in group 1 (p=1.0) and in 31% in group 2 (p=0.03); arterial bubbles in 32% divers in control group, in 0% in group 1 (p=0.02), in 15% in group 2 (p=0.42).

Conclusion: Safe diving recommendations avoiding decompression procedure led to the decrease in occurr­ ence of venous bubbles but not the elimination of arterial bubbles in divers with PFO. Transcatheter PFO closure led to elimination of arterial bubbles. The results suggest that transcatheter PFO closure might be an effective treatment in prevention of DCS: the effectivity of the up-to-date safety recommendations used needs to be further tested, especially in longitudinal clinical studies.

Keywords: patent foramen ovale; decompression sickness; simulated dive; transcranial Doppler ultrasonography; paradoxical embolism

Published: March 1, 2014  Show citation

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Novotný Š, Honěk J, Januška J, Šefc L, Horváth M, Fiedler J, et al.. Patent foramen ovale: transcatheter closure or conservative dive profile in decompression sickness prevention in divers? Cardiology Letters. 2014;23(3):223-227.
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