PFO surgery to diving. How long?

[waterdaughter]

My buddy is undergoing a PFO repair procedure next month. They had banned all diving and even swimming below the depth of a normal pool (8'). This was unacceptable to him and he was quite assertive with the cardiac specialists, in order to have the restriction lifted. The foramen is quite tiny and the surgeons informed him that they only agreed to the procedure because he is a professional diver.

They have told him that once the appliance is in place, heart muscle must then grow over it, before he may resume diving.

So, here's my question. I gather that the mesh that the device is constructed of is not sufficient, by itself, to prevent the passage of bubbles from atrium to atrium? This being the case, does anyone have an idea the usual rate at which heart muscle regenerates? I know that muscle growth is somewhat different than simple cell division...and I am somewhat familiar with the structure of heart muscle tissue and how it varies from normal striated muscle tissue. My guess would be that it is faster than nerves and slower than the normal striated...but hey, that's just a guess and still doesn't involve any sort of time frame (taking into acount that everyone is different).

What's the concensus? If the procedure is performed in June, will he dive this season? Maybe? Surely? (we are in Ontario and the "season" I am referrring to is wetsuit season, from now until Octoberish)

He does not see the specialist again until the final consult prior to the surgery and he asked me this last night.

Thanks for any info I can pass along...he is already overjoyed that his diving is not over, as initially thought...I would love to tell him that he could be in the water this summer. (well, there may be some selfish reasons as well )
W/D

 

[Dr. Doug Ebersole]

I'm a diving cardiologist in Florida who does PFO closures so here's my take on the situation. The concern with diving is that small bubbles that are usually cleared by the lungscan cross the PFO and result in a "paradoxic" (meaning from the right side to the left side of the heart) embolism to the brain, spinal cord, etc. The closure devices, as you menitoned, often do not totally close the PFO right away and must "endothelialize" (heal over). There will be a transesophageal echo (TEE) right after the procedure or maybe even an intracardiac echo during the procedure depending on the institution. A follow-up TEE is usually done a "couple" of months after the procedure. If that follow-up TEE shows the defect is totally closed, there is no reason your buddy could not resume diving. If you or he have any further quesitons, please PM me.

By the way, I don't know how your buddy was found to have a PFO, but according to Alfred Bove, MD in his textbook Diving Medicine in the chapter on evaluation of commercial divers he says ".......screening divers by echocardiography for a patent foramen ovale is not appropriate because this is a natural condition that can be found in a significant number of divers who have never and never will suffer decompression sickness or arterial gas embolism. It is worth considering only after two or more "undeserved" episodes of neurologic decompression sickness, especially if associated with cutaneous manifestations".

Just my two cents.