Going tech - Patent Foramen Ovale (PFO) testing?

[irsubmarine]

I had a girlfriend who happened to be a doctor who would research diving accidents when we would go on holiday. She did this to (presumably) scare me out of diving so I would spend more time with her. She brought up PFO based on a number of incidents she research and I learned how undeserved 'hits' are attributed to them. She was really adamant I see her cardiologist friend who would be happy to jam some device down into my heart in a painful session of torture, justified by me diving too much, to see if I would have a PFO. I'm not making that up, that's how she presented it to me. Obviously, I didn't go and now we are no longer together...

Fast forward a year or two to the present... in the next few weeks, I'm throwing myself down the rabbit hole and will do start down the tech path: TDI Sidemount, a slightly more advanced custom sidemount course, Advanced Nitrox and Deco Procedures. Going through the e-learning of the deco pro course I am reminded that 25% of the peoples of the world have PFO but do not know about it. Since the stakes are relatively higher with tech and my goals for diving far more serious than during my early recreational days, I kind of wish I did that cardiologist session of brimstone & torture to see if I have PFO after all.

So therefore a poll to see if you guys got tested for this birth anomaly. For those of you that got the test, how did it change your approach to diving, if any? Did all you that found you had PFO get it fixed? How long did that take and did you notice a difference after that in terms of post-dive fatigue etc?

Curious about all your feedback!

 

[JohnN]

I think a bubble diopter test is considered the best screening tools for a PFO. Minimally invasive (you're injected with a saline solution containing micro bubbles) They're detected usually at your temple. What is a bubble study? - Harvard Health I believe the cost to fix a PFO is somewhere in the $15K range (your insurance company will just laugh at you), I hope you (or your girlfriend) has deep pockets

 

[Nirvana]

I have not been tested for a PFO and I do not believe it is necessary for me to do so. The reason is that having a PFO is a very common condition, and not a reliable predictor of serious DCS. Absent any history of otherwise unexplained DCS, I would not think about undergoing surgery to repair a potentially present PFO.

 

[LiteHedded]

if you get bent a lot get tested for one. otherwise dont bother

 

[Patoux01]

I originally considered it. But, there's a but.

1) You pay from your own pocket (I'm in Europe, where healthcare is a thing) because it is a luxury thing. This is a minor thing for me though, I do value my health more than 200$ (probable cost of screening, maybe it's a bit more, unlikely to be huge). The closure operation is quite a large cost however.
2) Many DCS cases (I don't have the numbers, this could be wrong) lead to a PFO discovery. A PFO however, does not seem to lead to DCS. Do read this with the proper intent however. What I'm saying is that PFO =/= DCS. Sure, the probabilities are like 5 times higher or so, bringing them to 0.0005 instead of 0.0001, that's still "not much".
3) This is a regional thing, but there's people that, even if you get fixed, will not let you dive again.
4) There are other left-right shunts possible, such as pulmonary shunts.

There are multiple ways of testing it. http://www.jle.com/download/mca-268...ale_permeable--WuoZBH8AAQEAAGYVVTkAAAAH-a.pdf

The transesophageal echocardiography (TEE) with agitated saline contrast maneuver is considered the “gold standard” technique for the
detection of PFO. However, the limitations of this technique should be known, especially the possibility of false negative studies. Recent studies
have shown that detection of PFO with harmonic TTE is as sensitive as TEE and should be used in first line in association with TEE.
Echocardiography, especially TEE, gives also information about shunting characteristics, size of the PFO and the presence of associated atrial
septal aneurysm (ASA). This information may help to identify patients at higher risk of recurrence of cerebral events

Please feel to correct me if anything I said is wrong.

 

[northernone]

I have the option to test for free.

I've not felt the need yet as the correlation does not seen compelling enough that it's a screening I want to go through.

Mindful of it and am eagerly watching for new research.

Cameron

 

[StefinSB]

I had a stress done and ask them if they could add the bubble test to check for PFO. In Santa Barbara they do the test for the commercial divers at City College. Luckily it was negative for me. It is super cool seeing the micro bubbles enter your heart in the ultrasound.

 

[mattia_v]

Roughly one out of every four people have a PFO - in other words it's not a birth 'defect', but a normal anatomical variant. PFOs have been implicated in conditions where right to left shunting (or emboli) may cause problems (stroke and DCI), but whether closure is beneficial is a much more complex issue. And there is zero good evidence for pre-emptive closure (the procedure is not risk-free) in people without an event. As indicated above, the absolute risk remains low and seems associated with larger PFOs (insofar as the admittedly meager data allows for adequate risk estimation).

So no, I would personally not get it tested without good reason.

 

[jgttrey]

I've always understood that for the reasons identified above the consensus thinking was, even for tech diving, that PFO screening was only recommended if you've taken an undeserved hit or two.

Perhaps it's worth asking yourself what, if you got tested and found like many people you had a PFO, you would then do about it. Give up diving? Give up tech diving? Pad your deco for the rest of your life? Get it fixed at significant expense and low, but non-zero, risk?

Your inquiry is a fair and good question, to be sure. But, unless preemptive PFO screening yields "actionable intelligence" -- i.e., would change your behavior in a meaningful way, there may be little point in asking. But, YMMV. That's your call and I'm no doctor. I just haven't seen any of the authorities recommend routine screening of this type.

 

[PfcAJ]

I had a PFO and got it fixed.

Got bent a few time, but only on dives between 4 and 6hrs. Longer or shorter dives were fine. Self treated with oxygen, ibuprofen and suck-it-up. I was having symptoms way more than other people in my peer group, so I knew something was amiss.

Sure enough, you could see it clear as day on a trans-thoracic echo. Had it closed, and it’s been a total change in how I feel after longer dives. I’ve only had some mild fatigue after one dive and that involved swimming for over an hour at 260’ plus a somewhat suspect sawtooth deco. I earned that fatigue fair and square

I dived for years and did just fine, but I guess my inert gas loads on the longer dives was just too much. I think if I had stuck with shorter dives throughout my diving career I never would have suspected.

IMO if you aren’t getting bent just carry on. If you do have one and it’s asymptomatic... what are you gunna do? Insurance in the US probably isn’t going to pay for it, signing up for heart surgery for no practical reason is kind of nutty, and the dives you’re doing don’t cause you to get bent so... you’re now in a bit of a pickle.

Even though a trans-esophageal echo is the “gold standard”, I know at least one guy who had a false negative with TEE but showed positive on TTE, and subsequently had it closed.

If you are getting bent though, go get tested. It’ll change your life if you have one and get it fixed