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Deney A, Lairez O, Coulange M, Riu B, Hunt J. Recurrent decompression sickness and late repermeabilization of patent foramen oval closure prosthesis: a diver's dilemma-case report. Eur Heart J Case Rep 2024; 8:ytae371. [PMID: 39171132 PMCID: PMC11336998 DOI: 10.1093/ehjcr/ytae371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/12/2024] [Accepted: 07/23/2024] [Indexed: 08/23/2024]
Abstract
Background Decompression sickness (DCS) is a well-known risk associated with scuba diving, particularly in people with right-to-left shunt, such as patent foramen oval (PFO). Herein, we present a unique case of late PFO permeabilization after closure. Case summary A 26-year-old male diver was diagnosed with DCS following a dive at 36 m. He underwent PFO closure with a STARFLEX® prosthesis. Ten years later, the patient was presented with recurrent manifestations suggestive of DCS. The performed diagnostic work-up detects a permeabilization of the implanted prosthesis, and he was treated with a conservative approach. Discussion This case highlights the challenges in the management of PFO in divers and raises concerns about the long-term efficiency of PFO closure and the impact of diving-related factors on prosthesis patency.
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Affiliation(s)
- Antoine Deney
- Department of Cardiology, Rangueil University Hospital, 1, Avenue Jean Poulhès, TSA 50032, 31059 Toulouse, France
| | - Olivier Lairez
- Medical School, Toulouse III Paul Sabatier University, Toulouse, France
| | - Mathieu Coulange
- Department of Hyperbaric Medicine, Sainte Marguerite Hospital, APHM, Marseille, France
- Inserm 1263—Inra 1260, Team V: Adenosinergic System and Cardiovascular Disease, Bd Jean Moulin, Marseille, France
| | - Béatrice Riu
- Critical Care Unit, University Hospital of Purpan, 31300 Toulouse, France
| | - Jennifer Hunt
- Hyperbaric Center, University Hospital of Purpan, 31300 Toulouse, France
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Tello Montoliu A, Olea González A, Pujante Escudero Á, Martínez Del Villar M, de la Guía Galipienso F, Díaz González L, Fernández Olmo R, Freixa-Pamias R, Vivas Balcones D. Cardiovascular considerations on recreational scuba diving. SEC-Clinical Cardiology Association/SEC-Working Group on Sports Cardiology consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:566-573. [PMID: 38580141 DOI: 10.1016/j.rec.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/11/2024] [Indexed: 04/07/2024]
Abstract
The practice of recreational scuba diving has increased worldwide, with millions of people taking part each year. The aquatic environment is a hostile setting that requires human physiology to adapt by undergoing a series of changes that stress the body. Therefore, physical fitness and control of cardiovascular risk factors are essential for practicing this sport. Medical assessment is not mandatory before participating in this sport and is only required when recommended by a health questionnaire designed for this purpose. However, due to the significance of cardiovascular disease, cardiology consultations are becoming more frequent. The aim of the present consensus document is to describe the cardiovascular physiological changes that occur during diving, focusing on related cardiovascular diseases, their management, and follow-up recommendations. The assessment and follow-up of individuals who practice diving with previous cardiovascular disease are also discussed. This document, endorsed by the Clinical Cardiology Association of the Spanish Society of Cardiology (SEC) and the SEC Working Group on Sports Cardiology of the Association of Preventive Cardiology, aims to assist both cardiologists in evaluating patients, as well as other specialists responsible for assessing individuals' fitness for diving practice.
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Affiliation(s)
- Antonio Tello Montoliu
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain.
| | - Agustín Olea González
- Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain; Jefatura de Apoyo Sanitario de Cartagena, Armada Española, Cartagena, Murcia, Spain
| | - Ángel Pujante Escudero
- Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain
| | | | - Fernando de la Guía Galipienso
- Servicio de Cardiología, Policlínica Glorieta Denia, Denia, Alicante, Spain; Clínica Rehabilitación Marina Alta (REMA)/Cardiología Deportiva Denia, Denia, Alicante, Spain; Hospital Clínica Benidorm (HCB), Benidorm, Alicante, Spain
| | - Leonel Díaz González
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Clínica CEMTRO, Madrid, Spain
| | | | - Román Freixa-Pamias
- Servicio de Cardiología, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
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Apostolos A, Alexiou P, Papanikolaou A, Trantalis G, Drakopoulou M, Ktenopoulos N, Kachrimanidis I, Vlachakis PK, Tsakiri I, Chrysostomidis G, Aggeli K, Tsioufis C, Toutouzas K. Patent Foramen Ovale Closure in Special Clinical Situations: More Questions Than Answers? Life (Basel) 2024; 14:706. [PMID: 38929689 PMCID: PMC11204715 DOI: 10.3390/life14060706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Patent foramen ovale (PFO) is a remnant of the foetal circulation resulting from incomplete occlusion of the septum primum and septum secundum. Although prevalent in about 25% of the population, it mainly remains asymptomatic. However, its clinical significance in situations such as cryptogenic stroke, migraine, and decompression illness (DCI) has been well described. Recent randomised clinical trials (RCTs) have demonstrated the efficacy of percutaneous PFO closure over pharmacological therapy alone for secondary stroke prevention in carefully selected patients. Notably, these trials have excluded older patients or those with concurrent thrombophilia. Furthermore, the role of closure in other clinical conditions associated with PFO, like decompression sickness (DCS) and migraines, remains under investigation. Our review aims to summarise the existing literature regarding epidemiology, pathophysiological mechanisms, optimal management, and closure indications for these special patient groups.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Polyxeni Alexiou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Amalia Papanikolaou
- Department of Cardiology and Angiology, Universitatklinikum Essen, 451 47 Essen, Germany;
| | - Georgios Trantalis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Maria Drakopoulou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Ioannis Kachrimanidis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Panayotis K. Vlachakis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Ismini Tsakiri
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Grigorios Chrysostomidis
- Second Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Konstantina Aggeli
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Costas Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece; (A.A.); (P.A.); (G.T.); (M.D.); (N.K.); (I.K.); (P.K.V.); (I.T.); (K.A.); (C.T.)
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Devos P, Guedeney P, Montalescot G. Patent Foramen Ovale Percutaneous Closure: Evolution and Ongoing Challenges. J Clin Med 2023; 13:54. [PMID: 38202061 PMCID: PMC10780039 DOI: 10.3390/jcm13010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Patent foramen ovale (PFO) concerns nearly a quarter of the general population and incidence may reach up to 50% in patients with cryptogenic stroke. Recent randomized clinical trials confirmed that percutaneous closure of PFO-related stroke reduces the risk of embolic event recurrence. PFO also comes into play in other pathogenic conditions, such as migraine, decompression sickness or platypnea-orthodeoxia syndrome, where the heterogeneity of patients is high and evidence for closure is less well-documented. In this review, we describe the current indications for PFO percutaneous closure and the remaining challenges, and try to provide future directions regarding the technique and its indications.
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Affiliation(s)
- Perrine Devos
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
| | - Gilles Montalescot
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
- Institut de Cardiologie, Centre Hospitalier Universitaire, Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75013 Paris, France
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Honasoge AP, Suradi HS, Tobis JM, Kavinsky CJ. Patent Foramen Ovale Closure for Nonstroke Indications. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101135. [PMID: 39129903 PMCID: PMC11307832 DOI: 10.1016/j.jscai.2023.101135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 08/13/2024]
Abstract
The patent foramen ovale (PFO) is a flap or tunnel-like communication in the atrial septum present in 20% to 34% of the adult population. In most cases, it is a benign finding and poses no health risk. However, some PFOs may provide a conduit for bloodborne materials, such as thrombi, vasoactive substances, or air to pass into the systemic circulation causing a paradoxical embolus. PFOs have been linked with several clinical disease states including cryptogenic stroke, migraine headache, platypnea-orthodeoxia, and decompression illness. Percutaneous PFO closure provides a practical solution to the problem of PFO in carefully selected populations. Recent randomized control trials have demonstrated that PFO closure in patients with cryptogenic stroke is associated with reduced rates of recurrent stroke compared with medical therapy. This translated into a dramatic increase in the number of PFO closure procedures worldwide, primarily for the indication of cryptogenic stroke, with high procedural success and low complication rates. However, there are no randomized clinical trials available to support PFO closure in other clinical conditions. This article reviews potential indications, existing data, and management approaches for PFO closure in disorders other than cryptogenic stroke.
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Affiliation(s)
- Akilesh P. Honasoge
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Hussam S. Suradi
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | | | - Clifford J. Kavinsky
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Lee HJ, Lim DS, Lee J, Lee DG, Oh MY, Park J, Kim CH, Jung JH, Choi RK, Kang YC. Decompression Illness in Divers With or Without Patent Foramen Ovale : A Cohort Study. Ann Intern Med 2023. [PMID: 37429031 DOI: 10.7326/m23-0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND In previous studies, the prevalence of patent foramen ovale (PFO) has been reported to be higher in scuba divers who experienced decompression illness (DCI) than in those who did not. OBJECTIVE To assess the association between PFO and DCI in scuba divers. DESIGN Prospective cohort study. SETTING Tertiary cardiac center in South Korea. PARTICIPANTS One hundred experienced divers from 13 diving organizations who did more than 50 dives per year. MEASUREMENTS Participants had transesophageal echocardiography with a saline bubble test to determine the presence of a PFO and were subsequently divided into high- and low-risk groups. They were followed using a self-reported questionnaire while blinded to their PFO status. All of the reported symptoms were adjudicated in a blinded manner. The primary end point of this study was PFO-related DCI. Logistic regression analysis was done to determine the odds ratio of PFO-related DCI. RESULTS Patent foramen ovale was seen in 68 divers (37 at high risk and 31 at low risk). Patent foramen ovale-related DCI occurred in 12 divers in the PFO group (non-PFO vs. high-risk PFO vs. low-risk PFO: 0 vs. 8.4 vs. 2.0 incidences per 10 000 person-dives; P = 0.001) during a mean follow-up of 28.7 months. Multivariable analysis showed that high-risk PFO was independently associated with an increased risk for PFO-related DCI (odds ratio, 9.34 [95% CI, 1.95 to 44.88]). LIMITATION The sample size was insufficient to assess the association between low-risk PFO and DCI. CONCLUSION High-risk PFO was associated with an increased risk for DCI in scuba divers. This finding indicates that divers with high-risk PFO are more susceptible to DCI than what has been previously reported and should consider either refraining from diving or adhering to a conservative diving protocol. PRIMARY FUNDING SOURCE Sejong Medical Research Institute.
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Affiliation(s)
- Hyun-Jong Lee
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, South Korea (H.L., D.S.L., J.P., C.K., J.J.)
| | - Dal Soo Lim
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, South Korea (H.L., D.S.L., J.P., C.K., J.J.)
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, South Korea (J.L.)
| | - Dong-Geun Lee
- Department of Neurology, Pyeongtaek St. Mary's Hospital, Pyeongtaek, South Korea (D.L.)
| | - Mi-Young Oh
- Department of Neurology, Bucheon Sejong Hospital, Bucheon, South Korea (M.O.)
| | - Jinsik Park
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, South Korea (H.L., D.S.L., J.P., C.K., J.J.)
| | - Chi-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, South Korea (H.L., D.S.L., J.P., C.K., J.J.)
| | - Ji-Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, South Korea (H.L., D.S.L., J.P., C.K., J.J.)
| | - Rak Kyeong Choi
- Division of Cardiology, Department of Internal Medicine, Incheon Sejong Hospital, Incheon, South Korea (R.K.C.)
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Wilmshurst PT. The So-Called "Conservative Diving" Was Highly Provocative. JACC Cardiovasc Imaging 2022; 15:1834-1835. [PMID: 36202465 DOI: 10.1016/j.jcmg.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
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Honěk J, Šrámek M, Honěk T, Veselka J. Reply: The So-Called "Conservative Diving" Was Highly Provocative. JACC Cardiovasc Imaging 2022; 15:1835-1836. [PMID: 36202466 DOI: 10.1016/j.jcmg.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 06/16/2023]
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Tso JV, Powers JM, Kim JH. Response to: Correspondence on 'Cardiovascular considerations for scuba divers' by Wilmshurst et al. Heart 2022; 108:1416-1418. [PMID: 35853685 PMCID: PMC10511218 DOI: 10.1136/heartjnl-2022-321527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jason V Tso
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joshua M Powers
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan H Kim
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Wilmshurst P, Turner M, Bryson P, Edge C, Clamp M, Glover M. Correspondence on 'Cardiovascular considerations for scuba divers' by Tso et al. BRITISH HEART JOURNAL 2022; 108:1415-1416. [PMID: 35853686 DOI: 10.1136/heartjnl-2022-321526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Peter Wilmshurst
- Cardiology Department, Royal Stoke University Hospital, Stoke on Trent, UK
| | - Mark Turner
- Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | | | - Christopher Edge
- Anaethetic Department, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Margaret Clamp
- Occupational Health, MC Occupational Health, Nottingham, UK.,Medical Advisor, British Sub-Aqua Club and Sub-Aqua Association, Ellesmere Port, UK
| | - Mark Glover
- Hyperbaric Medicine Unit, St Richard's Hospital, Chichester, UK
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Apostolos A, Drakopoulou M, Trantalis G, Synetos Α, Oikonomou G, Karapanayiotides T, Tsioufis C, Toutouzas K. The management of patent foramen ovale in divers: where do we stand? Ther Adv Neurol Disord 2022; 15:17562864221103459. [PMID: 35837370 PMCID: PMC9274415 DOI: 10.1177/17562864221103459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Diving is a fascinating activity, but it does not come without any cost; decompression illness (DCI) is one of the most frequent diseases occurring in divers. Rapid surfacing after diving causes alveolar rupture and bubbles release, which enter in the systemic circulation and could embolize numerous organs and tissues. The presence of patent foramen ovale (PFO) contributes to the passage of venous gas bubbles into the arterial circulation, increasing the risk of complications related to DCI. The diagnosis is established with a detailed medical history, a comprehensive clinical evaluation, and a multimodal imaging approach. Although the percutaneous closure of PFO is ambiguous for divers, as a primary prevention strategy, transcatheter management is considered as beneficial for DCI recurrence prevention. The aim of this study is to introduce the basic principles of DCI, to review the pathophysiological connection between DCI and PFO, to highlight the risk factors and the optimal treatment, and, last but not least, to shed light on the role of closure as primary and secondary prevention.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Trantalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Αndreas Synetos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Oikonomou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Theodoros Karapanayiotides
- Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Costas Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- Professor of Cardiology, First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, 114 Vasilissis Sophias Avenue, Athens 115 27, Greece
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12
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Patent foramen ovale closure and decompression sickness among divers. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:160-162. [PMID: 34810112 DOI: 10.1016/j.carrev.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Decompression sickness is a diving-related disease that results in various clinical manifestations, ranging from joint pain to severe pulmonary and CNS affection. Complications of this disease may sometimes persist even after treatment with hyperbaric oxygen therapy. In addition, it may hamper the quality of life by forcing divers to restrict their recreational practice. The presence of a patent foramen ovale (PFO) increases the risk of decompression sickness by facilitating air embolization. Therefore, PFO closure may play a role in reducing such complications. However, PFO closure remains associated with its own set of risks and complications. We sought to assess the benefit and harm of PFO closure for the prevention of decompression sickness in divers. METHODS We conducted a comprehensive search of MEDLINE, Embase, CENTRAL, and Web of Science. Two-armed studies comparing the incidence of decompression sickness with or without PFO closure were included. We used a random-effects model to compute risk ratios comparing groups undergoing PFO closure to those not undergoing PFO closure. RESULTS Four observational studies with a total of 309 divers (PFO closure: 141 and no closure: 168) met inclusion criteria. PFO closure was associated with a significantly lower incidence of decompression sickness (PFO-closure: 2.84%; no closure: 11.3%; RR: 0.29; 95% CI: 0.10 to 0.89; NNTB = 11), with low heterogeneity (I2 = 0%). The mean follow-up was 6.12 years (Standard deviation 0.70). Adverse events occurred in 7.63% of PFO closures, including tachyarrhythmias and bleeding. CONCLUSION PFO closure may potentially reduce the risk of decompression sickness among divers; however, it is not free of potential downsides, with nearly one in thirteen patients in our analysis experiencing an adverse event.
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Germonpré P, Lafère P, Portier W, Germonpré FL, Marroni A, Balestra C. Increased Risk of Decompression Sickness When Diving With a Right-to-Left Shunt: Results of a Prospective Single-Blinded Observational Study (The "Carotid Doppler" Study). Front Physiol 2021; 12:763408. [PMID: 34777020 PMCID: PMC8586212 DOI: 10.3389/fphys.2021.763408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Divers with a patent Foramen Ovale (PFO) have an increased risk for decompression sickness (DCS) when diving with compressed breathing gas. The relative risk increase, however, is difficult to establish as the PFO status of divers is usually only determined after a DCS occurrence. Methods: This prospective, single-blinded, observational study was designed to collect DCS data from volunteer divers after screening for right-to-left shunt (RLS) using a Carotid Doppler test. Divers were blinded to the result of the test, but all received a standardized briefing on current scientific knowledge of diving physiology and “low-bubble” diving techniques; they were then allowed to dive without restrictions. After a mean interval of 8 years, a questionnaire was sent collecting data on their dives and cases of DCS (if any occurred). Results: Data was collected on 148 divers totaling 66,859 dives. There was no significant difference in diving data between divers with or without RLS. Divers with RLS had a 3.02 times higher incidence of (confirmed) DCS than divers without RLS (p = 0.04). When all cases of (confirmed or possible DCS) were considered, the Relative Risk was 1.42 (p = 0.46). DCS occurred mainly in divers who did not dive according to “low-bubble” diving techniques, in both groups. Conclusion: This prospective study confirms that DCS is more frequent in divers with RLS (such as a PFO), with a Relative Risk of 1.42 (all DCS) to 3.02 (confirmed DCS). It appears this risk is linked to diving behavior, more specifically diving to the limits of the adopted decompression procedures.
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Affiliation(s)
- Peter Germonpré
- Centre for Hyperbaric Oxygen Therapy, Military Hospital, Brussels, Belgium.,Divers Alert Network (DAN) Europe Research Division, Roseto, Italy
| | - Pierre Lafère
- Centre for Hyperbaric Oxygen Therapy, Military Hospital, Brussels, Belgium.,Divers Alert Network (DAN) Europe Research Division, Roseto, Italy.,Environmental & Occupational, Ageing (Integrative) Physiology Lab, Haute Ecole Bruxelles-Brabant (HE2B), Auderghem, Belgium
| | - William Portier
- Centre for Hyperbaric Oxygen Therapy, Military Hospital, Brussels, Belgium
| | | | - Alessandro Marroni
- Environmental & Occupational, Ageing (Integrative) Physiology Lab, Haute Ecole Bruxelles-Brabant (HE2B), Auderghem, Belgium
| | - Costantino Balestra
- Divers Alert Network (DAN) Europe Research Division, Roseto, Italy.,Environmental & Occupational, Ageing (Integrative) Physiology Lab, Haute Ecole Bruxelles-Brabant (HE2B), Auderghem, Belgium.,Physical Activity Teaching Unit, Motor Sciences Department, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Orsinelli DA, Rajpal S. Doing a Deep Dive on Patent Foramen Ovale: Stay Tuned in the PFO World. JACC Cardiovasc Imaging 2021; 15:190-192. [PMID: 34656484 DOI: 10.1016/j.jcmg.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/24/2021] [Accepted: 09/09/2021] [Indexed: 11/24/2022]
Affiliation(s)
- David A Orsinelli
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Nationwide Children's Hospital, Columbus, Ohio, USA.
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