PFO and repair process

[kraken]

Hi -

Just got back from the hospital, was told I have a PFO (saw it on the screen). Doctor advised getting it repaired, but not for diving reasons. My question is, does anyone know or have links to articles that cover the effects of pressure on hte repair device? ie. after it is repaired can I continue to dive normally or will I have depth restrictions placed on me? My doctor is not a diver and could not answer these questions.

 

[RTodd]

Hi -

Just got back from the hospital, was told I have a PFO (saw it on the screen). Doctor advised getting it repaired, but not for diving reasons. My question is, does anyone know or have links to articles that cover the effects of pressure on hte repair device? ie. after it is repaired can I continue to dive normally or will I have depth restrictions placed on me? My doctor is not a diver and could not answer these questions.

Commercial divers get them repaired and return to normal diving. However, these people are making six figure salaries diving and many would probably not make a quarter of that if they could not dive. So, totally different incentive.

I have no medical background on when docs would recommend repair for non-diving reasons. (Given the large percentage of the popotulation that has this to one degree or the other, I don't think repair is the norm. But, this is clueless internet speculation.) Since it isn't the norm, you may have other issues that would lead you to consider whether diving is worth it even post-surgery. I would discuss this with a hyparbaric doc, preferably one that has significant familiarity with commercial divers and this particular issue.

 

[knotical]

Some background info in a 2-part article:
http://divermag.com/archives/april99/divedoctor_apr99.html
http://divermag.com/archives/may99/divedoctor_may99.html

 

[boomx5]

Hi -

Just got back from the hospital, was told I have a PFO (saw it on the screen). Doctor advised getting it repaired, but not for diving reasons. My question is, does anyone know or have links to articles that cover the effects of pressure on hte repair device? ie. after it is repaired can I continue to dive normally or will I have depth restrictions placed on me? My doctor is not a diver and could not answer these questions.

I know people who have had them repaired and continued diving normally. They also say that a PFO can be a contributing factor to strokes....the medical type not the diving type.

 

[kraken]

I know people who have had them repaired and continued diving normally. They also say that a PFO can be a contributing factor to strokes....the medical type not the diving type.

Boomx5, that is the reason he gave to have it repaired. He said many of his stroke patients have PFOs. My mind immediately went to the long international flights where you can bulid clots in your legs, the doc said they could use the PFO to get lodged in the brain and blammo, stroke.

 

[boomx5]

Boomx5, that is the reason he gave to have it repaired. He said many of his stroke patients have PFOs. My mind immediately went to the long international flights where you can bulid clots in your legs, the doc said they could use the PFO to get lodged in the brain and blammo, stroke.

What test did you take to find out you had a PFO?

 

[kraken]

What test did you take to find out you had a PFO?

transesophageal echocardiography (TEE). The one where they shove and I mean shove this huge tube down your throat. It was a bad experience (nice people at the hospital), but I believe it violated the geneva conventions. It was cool to watch my heart.

The bubble portion of the test came back negative, but when I coughed (have a cold), you could see the flap open up a little.

I just spoke with the people from DAN and read the above documents. Basically, I'm ok to dive, but need to turn in my deco tanks. The people from DAN also said there are some serious considerations before getting the PFO repaired.

I totally fit the profile, 601 dives. was hydrated, rested, did all my stops according to plan, etc. Should not have been hit... but got a type II just after walking up 5 flights of stairs to my room.

Of course my buddy that owns the resort where I got bent last july sent the most amazing mimic octopus and manderin goby shots from dives last week. I'm being teased

 

[RTodd]

transesophageal echocardiography (TEE). The one where they shove and I mean shove this huge tube down your throat. It was a bad experience (nice people at the hospital), but I believe it violated the geneva conventions. It was cool to watch my heart.

The bubble portion of the test came back negative, but when I coughed (have a cold), you could see the flap open up a little.

I just spoke with the people from DAN and read the above documents. Basically, I'm ok to dive, but need to turn in my deco tanks. The people from DAN also said there are some serious considerations before getting the PFO repaired.

I totally fit the profile, 601 dives. was hydrated, rested, did all my stops according to plan, etc. Should not have been hit... but got a type II just after walking up 5 flights of stairs to my room.

Of course my buddy that owns the resort where I got bent last july sent the most amazing mimic octopus and manderin goby shots from dives last week. I'm being teased

Being hyper paranoid, I had the TEE too. I don't remember the test. I remember the weeks of pain afterwards though.

Heart surgery for a potential risk is definately not something to take lightly. While just avoiding deco diving probably puts you back in the same risk as the general population the tables were built around, you are still one of the outliers at much greater risk for a Type II. Not a good place to be. And, if it matters, these concerns are coming from someone that views occasional Type I hits as the price paid to do certain types of diving.

 

[boomx5]

transesophageal echocardiography (TEE). The one where they shove and I mean shove this huge tube down your throat. It was a bad experience (nice people at the hospital), but I believe it violated the geneva conventions. It was cool to watch my heart.

The bubble portion of the test came back negative, but when I coughed (have a cold), you could see the flap open up a little.

I just spoke with the people from DAN and read the above documents. Basically, I'm ok to dive, but need to turn in my deco tanks. The people from DAN also said there are some serious considerations before getting the PFO repaired.

I totally fit the profile, 601 dives. was hydrated, rested, did all my stops according to plan, etc. Should not have been hit... but got a type II just after walking up 5 flights of stairs to my room.

Of course my buddy that owns the resort where I got bent last july sent the most amazing mimic octopus and manderin goby shots from dives last week. I'm being teased

Yeah, I heard the TEE was a bad experience...the best test there is for a PFO but a real violating experience. On the other hand, it would sure suck to take a hit and end up in a wheel chair if I could have avoided it all together. I know a guy who dove in the 300' range for a few years and then found out he had a PFO. He never took a hit, but he got it repaired just in case. He said when he had the surgery done, he went home that afternoon and there were no problems. I really need a PFO test done, but I'm not really wanting to go through with the TEE.

 

[Dr. Doug Ebersole]

As an interventional cardiologist, I thought I should pipe in. There is an association of PFO (patent foramen ovale) and cryptogenic stroke, meaning no other cause can be found. The suspicion is that small blood clots can travel across from the right side of the heart (where these small clots would be filtered by the lung) to the left side where they can embolize to the brain and cause stroke. PFO has also been implicated in dcompression illness in that small bubbles (which also might be cleared by the lungs) can cross over to the left side and embolize to the brain or elsewhere.

In the past the only way to fix a PFO required heart surgery. For stroke prevention the alternative to surgery was anticoagulation therapy with Coumadin. While this is helpful in decreasing clot problems, it would have no effect on bubble issues. There are now two different devices approved by the FDA for PFO closure percutaneously (catheter based like a heart cath and not with surgery). This procedure usually only requires a one day hospital stay and very little in terms of "recovery" time. It is an invasive procedure, however, and does involve small risks. I'm sure there is a cardiologist in your area who is experienced in using these devices who could render an opinion as to whether this would be an option for you.

The risk of the PFO with diving depends on what kind of diving you are doing and is based on the likelihood of bubble formation. Very shallow recreational diving is much lower risk than prolonged deep dives requiring long deco stops. However, as we all know even the most conservative profiles have some risk of DCS. Therefore, while it is reasonable to advise divers with PFO not to be technical or commercial divers, this doesn't completely remove the risk.

If you have any other questions, feel free to PM me.