New published paper on PFOs

[tridacna]

Just saw this. Interesting.

New Data Back Closing Large PFOs to Prevent Decompression Sickness in Divers

 

[Pressurehead]

From this site: ‘Well look, I like diving but it's not my life, and if I have a PFO and there is some risk, I'd like to know and then I'll stop diving. I'll go snorkeling instead,’” he observed. “I would not prohibit a patient from diving even if they knew they had a PFO, but it might change somebody's own view of how they want to do it.”
Says it all.

 

[michael-fisch]

Other reasons to get a PFO closed:
Many migrane sufferers (possibly most migrane sufferers) have a PFO - after closing the PFO the incidences of migranes diminishes greatly.
People with a PFO are much more likely to suffer strokes, fixing the PFO greatly reduces the likelyhood of getting a stroke.

Michael

 

[michael-fisch]

In Europe, with socialized medicine, getting a PFO fixed for diving (unless diving is your main job) means that you'll pay for the operation yourself.
If you get the operation to prevent a stroke the insurance pays for the operation and treatment.

Michael

 

[Duke Dive Medicine]

Just saw this. Interesting.

New Data Back Closing Large PFOs to Prevent Decompression Sickness in Divers

This is an interesting paper. Transcranial doppler can be used as a screening tool for PFO, but TCD alone can't differentiate between PFO and other types of atrial septal defect. The authors say that transesophageal echocardiography (TEE) "...was offered to divers: 1) with a history of DCS; 2) with a grade 3 shunt on TCCS; and 3) in whom TCCS examination was unsuccessful (insufficient bone window)." They don't say how many divers accepted the offer, which could just be an oversight, but it could also skew the numbers if enough divers refused it.

I also wonder about their definition of unexplained DCS: "An unprovoked DCS was defined as any DCS symptom (emphasis mine) that originated <24 hours after a dive or series of dives that complied with all the rules advised to recreational divers, as described previously (7)." Earlier in the paper they acknowledge that PFO is associated with neurological DCS and cutaneous DCS, but it's not clear whether they're applying that criteria in their study because they don't list the symptoms the divers experienced. Again maybe an oversight.

They did follow 55 divers after PFO closure, a significant number, and their data support the assertion that closure can decrease the risk of DCS. They also reported no complications outside minor bleeding at the sheath site in two individuals, which is reassuring to people who are considering closure.

Tagging @Dr. Doug Ebersole - Doug, I think readers would value your take on this.

Best regards,
DDM

 

[J-Vo]

As I'm about to have a closure, I found this interesting. I was however taken aback when I saw this paragraph:

"The general incidence of PFO would mean that one-quarter of all divers have one, Thaler pointed out. “And if decompression sickness was so common amongst divers with PFOs, I would think there would be a lot more decompression sickness,” he said. “If you dive well, diving is pretty safe. You shouldn't get decompression sickness if you do it properly. This is for the subgroup who for whatever reason come up too quickly or stay down too long or go flying too soon after. Those are the reasons people end up with decompression sickness. But otherwise, you probably shouldn't get it.”"

New Data Back Closing Large PFOs to Prevent Decompression Sickness in Divers

 

[Divin'Papaw]

Interesting. If I were to find out that I had a PFO I would probably just leave it alone given that I've never had DCS. I would most likely dive a bit more conservatively perhaps but I am already a conservative, cautious diver. If I were still a technical diver doing frequent long decompression dives, I would probably pursue having it closed. I have a friend who is a big time rebreather technical diver. He found out that he had a PFO after a couple of hits. He went ahead and had his closed.

 

[J-Vo]

I have a friend who is a big time rebreather technical diver. He found out that he had a PFO after a couple of hits. He went ahead and had his closed.

This pretty well describes me, although I haven't had any hits since I got the breather. When I tell people what gradient factors I'm running they are surprised I have had any hits, and also sometimes let me know upfront they don't plan to wait for me during decompression.

 

[kmarks]

It's estimated that between 10-30% of the population has a PFO. For most of these people, it's a silent issue and never causes them any trouble and will never be noticed because you have to go looking for it to find it. The reason it is a concern for most people is because it allows deoxygenated blood to bypass the lungs and get pumped right back into the body. If you are an athlete or if the PFO is severe, it can lead to hypoxia, which can be fatal. For divers, we add on a second concern which is that it allows blood with a higher ppN2 to bypass the lungs, thereby reducing your elimination of residual nitrogen on ascent. The surgery to close a PFO is quick and has a very high success rate. Personally, if I found out I had one, I'd get it closed.

 

[Duke Dive Medicine]

I merged the two threads on the subject since it's the same article in both threads.

Best regards,
DDM