PFO - TEE Test Required to Continue Diving

[curiousdiver88]

Hi Everyone!

Incidentally, I found out I have a probable PFO through a TTE bubble study. It was mostly discovered due to a work up evaluating some vision problems and a history of infrequent post exertional ocular migraine. I have not had a stroke, TIA, or DCS. I'm a relatively new diver, only having performed 10 dives before finding this out. According to my cardiologist, it's a "mild-to-moderate right-to-left shunt." I'm wondering if it is still important to obtain a TEE to confirm the actual size and anatomy of the shunt in order to continue diving? Or, could I follow DANs conservative diving practices with the information I already have?

I'm a little confused on exactly how much testing I need to do in order for it to be safe to continue diving as I feel I'm in a really grey area finding this incidentally. I really appreciate any insight you have!

 

[curiousdiver88]

@Dr. Doug Ebersole you seem to be of great help to this community with knowledge on PFOs, so I thought I would tag you as I'd love your input/expertise!

Thank you!

 

[rsingler]

A moderate right to left shunt makes this a non-trivial question. I would definitely consult a diving cardiologist like @Dr. Doug Ebersole

 

[Dr. Doug Ebersole]

Approximately 25% of people (and divers) have PFOs. The vast majority don't even know it. As best we can guess, having a PFO increases your risk of DCS by about 5 fold. While this sounds bad, it is a RELATIVE risk. The ABSOLUTE risk of DCS with a PFO is still very small. For recreational diving, the risk of DCS is around 2 episodes per 10,000 dives. A 5-fold increase in this would be 10 per 10,000 or 1 per 1000 dives -- a very low risk. This is why we do not recommend routine screening for PFOs in divers or routine closure of PFOs if they are found incidentally.

If you were incidentally found to have a PFO on an echo done for another reason, I would simply recommend diving conservatively. As a new recreational diver, this would include no decompression diving, no dives deeper than 100 feet, diving nitrox with air profiles, doing prolonged safety stops, and avoiding heavy exertion for several hours after diving. There is no need to go to a TEE unless there is a reason to close the PFO such as cryptogenic stroke or recurrent DCS of certain types (cerebral, spinal, inner ear, cutaneous) despite the conservative diving practices mentioned above. Even then, I frequently do PFO closures based on the transthoracic echo findings without going to a TEE.

PM me should you have more questions.