Recurrent Inner Ear Decompression Sickness Associated With a Patent Foramen Ovale

Introduction: Interatrial communication is associated with an increased risk of decompression sickness (DCS) in scuba diving. It has been proposed that there would be a decreased risk of DCS after closure of the interatrial communication, i.e., persistent (patent) foramen ovale (PFO). However, the clinical evidence supporting this is limited. Methods: Medical records were reviewed to identify Swedish scuba divers with a history of DCS and catheter closure of an interatrial communication. Thereafter, phone interviews were conducted with questions regarding diving and DCS. All Swedish divers who had had catheter-based PFO-closure because of DCS were followed up, assessing post-closure diving habits and recurrent DCS. Results: Nine divers, all with a PFO, were included. Eight were diving post-closure. These divers had performed 6,835 dives (median 410, range 140–2,200) before closure, and 4,708 dives (median 413, range 11–2,000) after closure. Seven cases with mild and 10 with serious DCS symptoms were reported before the PFO closure. One diver with a small residual shunt suffered serious DCS post-closure; however, that dive was performed with a provocative diving profile. Conclusion: Divers with PFO and DCS continue to dive after PFO closure and this seems to be fairly safe. Our study suggests a conservative diving profile when there is a residual shunt after PFO closure, to prevent recurrent DCS events.

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Patent Foramen Ovale in Fetal Life, Infancy and Childhood

Medical Sciences ◽

10.3390/medsci8030025 ◽

2020 ◽

Vol 8 (3) ◽

pp. 25

Author(s):

Bibhuti B. Das

Keyword(s):

Patent Foramen Ovale ◽

Life Support ◽

Decompression Sickness ◽

Cryptogenic Stroke ◽

Anatomical Variations ◽

Fetal Life ◽

Foramen Ovale ◽

Ventricular Assist ◽

Echocardiographic Finding ◽

Diagnostic Modalities

A patent foramen ovale (PFO) is a common, incidental echocardiographic finding in otherwise healthy and asymptomatic infants and children. However, a variety of clinical conditions have been ascribed to the presence of a PFO in childhood, such as cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine, although the data on these are controversial and sometimes contradictory. This review discusses embryology and correlation with post-natal anatomy, anatomical variations of the atrial septum, diagnostic modalities in special circumstances of PFO associated clinical syndromes, and the role of PFO in congenital heart disease, pulmonary hypertension, dilated cardiomyopathy and heart failure in children who require an extracorporeal membrane oxygenator or ventricular assist device as life support.

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THE FRACTAL APPROACH AS A TOOL TO UNDERSTAND ASYMPTOMATIC BRAIN HYPERINTENSE MRI SIGNALS

Fractals ◽

10.1142/s0218348x0400232x ◽

2004 ◽

Vol 12 (01) ◽

pp. 67-72 ◽

Cited By ~ 15

Author(s):

COSTANTINO BALESTRA ◽

ALESSANDRO MARRONI ◽

BRIGITTE FARKAS ◽

PHILIPPE PEETRONS ◽

FRÉDÉRIC VANDERSCHUEREN ◽

...

Keyword(s):

Patent Foramen Ovale ◽

Statistical Difference ◽

Decompression Sickness ◽

Brain Lesion ◽

Foramen Ovale ◽

Fractal Approach ◽

Post Test ◽

Vascular Origin ◽

Magnetic Resonance Investigation ◽

The Brain

The prevalence of a Patent Foramen Ovale is described in merely 30% of the asymptomatic population. This patency has been shown to be an increasing risk factor for paradoxical cerebral embolization. Some desaturation or decompression situations in human activities such as scuba diving or altitude flight are prone to provoke embolisations. The association with the presence of a patent Foramen Ovale and the onset of cerebral decompression sickness seems to be presenting an odds ratio value of about 5.1.1 The presence of asymptomatic brain lesion-like "spots" has been investigated in a randomized population of diving individuals (n=42 randomized out of 200). The inclusion criteria were drastic and included: age (less than 41 years of age); diving experience (more than 200 logged dives); no decompression sickness episodes; no contraindications for the MRI examination; and no known central nervous system conditions. Data of the magnetic resonance investigation of the brain has been performed in 42 (diving) volunteers fully informed on the experimental procedures. The statistical comparison (Anova test after Kolmogorov-Smirnov compatibility testing and Neuman–Keuls discriminant post-test) of the fractal dimension obtained by means of the box counting method with the slope analysis (Harfa fractal analysis program). The comparison was performed with known pathological images such as multiple sclerosis (a pathology not emerging from vascular problems), ischemic thrombotic lesions (vascular problem), diver's asymptomatic brain spots, and the arteriography of the internal carotid in non-pathological humans (clearly vascular). The statistical difference (p<0.001) between the vascular related images, as well as the absence of statistical difference (p>0.05) with the non-vascular spots images advocates with a non-vascular origin of the diver's asymptomatic spots and thus the link between the patency of the cardiac Foramen Ovale and the brain "spots" seems not to be as clear as it was believed.

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Inner Ear Decompression Sickness in Sport Compressed-Air Diving

The Laryngoscope ◽

10.1097/00005537-200105000-00018 ◽

2001 ◽

Vol 111 (5) ◽

pp. 851-856 ◽

Cited By ~ 32

Author(s):

Zohar Nachum ◽

Avi Shupak ◽

Orna Spitzer ◽

Zohara Sharoni ◽

Ilana Doweck ◽

...

Keyword(s):

Inner Ear ◽

Decompression Sickness ◽

Compressed Air ◽

Inner Ear Decompression Sickness

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Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

Polish Hyperbaric Research ◽

10.2478/phr-2019-0008 ◽

2019 ◽

Vol 67 (2) ◽

pp. 93-102

Author(s):

Krzysztof Dziewiatowski ◽

Piotr Siermontowski

Keyword(s):

Left Atrium ◽

Sensitivity And Specificity ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Decompression Sickness ◽

Adult Population ◽

Venous Blood ◽

Arterial System ◽

Foramen Ovale ◽

Contrast Enhanced

Abstract Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.

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