Decompression sickness after a highly conservative dive in a diver with known persistent foramen ovale: Case report

2021 ◽  
Vol 51 (1) ◽  
pp. 111-115
Author(s):  
William Brampton ◽  
◽  
Martin DJ Sayer ◽  
◽  
Keyword(s):  
Decompression Sickness ◽  
Position Statement ◽  
Valsalva Manoeuvre ◽  
Foramen Ovale ◽  
Spinal Decompression ◽  
Previous Episode ◽  
The United Kingdom ◽  
Initial Symptoms ◽  
Persistent Foramen Ovale ◽  
Symptoms And Signs

A diver returned to diving, 15 months after an episode of neuro-spinal decompression sickness (DCS) with relapse, after which she had been found to have a moderate to large provoked shunt across a persistent (patent) foramen ovale (PFO), which was not closed. She performed a single highly conservative dive in line with the recommendations contained in the 2015 position statement on PFO and diving published jointly by the South Pacific Underwater Medicine Society and the United Kingdom Sports Diving Medical Committee. An accidental Valsalva manoeuvre shortly after surfacing may have provoked initial symptoms which later progressed to DCS. Her symptoms and signs were milder but closely mirrored her previous episode of DCS and she required multiple hyperbaric oxygen treatments over several days, with residua on discharge. Although guidance in the joint statement was mostly followed, the outcome from this case indicates that there may be a subgroup of divers with an unclosed PFO, who have had a previous episode of serious DCS, who may not be safe to dive, even within conservative limits.

scholarly journals Persistent foramen ovale closure in divers with a history of decompression sickness

2018 ◽  
Vol 26 (11) ◽  
pp. 535-539 ◽  
Author(s):  
R. Koopsen ◽  
P. R. Stella ◽  
K. M. Thijs ◽  
R. Rienks
Keyword(s):  
Decompression Sickness ◽  
Foramen Ovale ◽  
History Of ◽  
Persistent Foramen Ovale

scholarly journals A review of diving practices and outcomes following the diagnosis of a persistent (patent) foramen ovale in compressed air divers with a documented episode of decompression sickness

2020 ◽  
Vol 50 (4) ◽  
pp. 363-369
Author(s):  
Christopher W Scarff ◽  
◽  
John Lippmann ◽  
Andrew W Fock ◽  
◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Risk Mitigation ◽  
Position Statement ◽  
Compressed Air ◽  
Asia Pacific ◽  
Foramen Ovale ◽  
Post Intervention ◽  
History Of ◽  
Almost All

(Scarff CW, Lippmann J, Fock AW. A review of diving practices and outcomes following the diagnosis of a persistent (patent) foramen ovale in compressed air divers with a documented episode of decompression sickness. Diving and Hyperbaric Medicine. 2020 December 20;50(4):363–369. doi: 10.28920/dhm50.4.363-369. PMID: 33325017.) Introduction: The presence of a persistent (patent) foramen ovale (PFO) increases the risk of decompression sickness (DCS) whilst diving with pressurised air. After the diagnosis of a PFO, divers will be offered a number of options for risk mitigation. The aim of this study was to review the management choices and modifications to diving practices following PFO diagnosis in the era preceding the 2015 joint position statement (JPS) on PFO and diving. Methods: A retrospective study was conducted of divers sourced from both the Alfred Hospital, Melbourne and the Divers Alert Network Asia-Pacific during the period 2005–2015. Divers were contacted via a combination of phone, text, mail and email. Data collected included: diving habits (years, style and depths); DCS symptoms, signs and treatment; return to diving and modifications of dive practices; history of migraine and echocardiography (ECHO) pre- and post-intervention; ECHO technique(s) used, and success or failure of PFO closure (PFOC). Analyses were performed to compare the incidence of DCS pre- and post-PFO diagnosis. Results: Seventy-three divers were interviewed. Sixty-eight of these returned to diving following the diagnosis of PFO. Thirty-eight underwent PFOC and chose to adopt conservative diving practices (CDPs); 15 chose PFOC with no modification to practices; 15 adopted CDPs alone; and five have discontinued diving. The incidence of DCS decreased significantly following PFOC and/or adoption of conservative diving practices. Of interest, migraine with aura resolved in almost all those who underwent PFOC. Conclusions: Many divers had already adopted practices consistent with the 2015 JPS permitting the resumption of scuba diving with a lowering of the incidence of DCS to that of the general diving population. These results support the recommendations of the JPS.

Does persistent (patent) foramen ovale closure reduce the risk of recurrent decompression sickness in scuba divers?

2021 ◽  
Vol 51 (1) ◽  
pp. 63-67
Author(s):  
Björn Edvinsson ◽  
◽  
Ulf Thilén ◽  
Niels Erik Nielsen ◽  
Christina Christersson ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Foramen Ovale ◽  
Residual Shunt ◽  
Interatrial Communication ◽  
Scuba Divers ◽  
Increased Risk ◽  
History Of ◽  
Catheter Closure ◽  
Pfo Closure

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.

scholarly journals The relation between initial symptoms and signs and the prognosis of whiplash

2001 ◽  
Vol 10 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Samy Suissa ◽  
Susan Harder ◽  
Martin Veilleux
Keyword(s):  
Initial Symptoms ◽  
Symptoms And Signs

How the Brain Moves the Eyes

2014 ◽  
pp. 1-25
Author(s):  
Shirley H. Wray
Keyword(s):  
Cardiac Surgery ◽  
Eye Movements ◽  
Progressive Supranuclear Palsy ◽  
Disease Progression ◽  
Frontotemporal Dementia ◽  
Smooth Pursuit ◽  
Cortical Areas ◽  
Initial Symptoms ◽  
The Brain ◽  
Symptoms And Signs

discusses the brain’s visual architecture for directing and controlling of eye movements:the striate, frontal and parietal cortical areas; and the eye movements themselves—saccades, smooth pursuit, and vergence. The susceptibility to disorders of these systems is illustrated in four detailed cases that follow disease progression from initial symptoms and signs to diagnosis and treatment. The case studies and video displays include a patient with Pick’s disease (frontotemporal dementia), another with Alzheimer’s dementia, and two examples of rare saccadic syndromes, one a patient with the slow saccade syndrome due to progressive supranuclear palsy and one with selective saccadic palsy following cardiac surgery.

285Arrhythmias after transcatheter closure of persistent foramen ovale are related to the type and size of the implanted device

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Komar ◽  
T Przewlocki ◽  
P Prochownik ◽  
U Gancarczyk ◽  
B Sobien ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Lower Risk ◽  
Transcatheter Closure ◽  
Supraventricular Arrhythmias ◽  
Foramen Ovale ◽  
Av Conduction ◽  
Persistent Foramen Ovale ◽  
Premature Beats ◽  
Pfo Closure

Abstract Transient supraventricular arrhythmias may occur in patients following persistent foramen ovale (PFO) closure. Therefore, the aim of the study was to prospectively perform 24-hour ECG monitoring to assess the electrocardiographic effects of transcatheter closure of PFO depending on the type of implanted devices. Material and methods 351 consecutive adult subjects (196 F, 155M; mean age: 40.9±15.3) were enrolled into the study to undergo PFO closure with an Amplatzer Septal Occluder - ASO (157 pts: 117 occluders – size 25; 40 pts – size 30), and Cardia device (194 pts: 163 occluders – size 25; 31 – size 30). Holter monitoring was performed on all patients before, at 1 and 12 months after the procedure. Results The success rate of PFO closure was 97.8% (351 cases from 359 qualified in TEE), in 8 cases the PFO tunnels were too small to be forced by a catheter, in one case the PFO device caused an injury of the septum and an ASD Amplatzer device was implanted. During the procedure in 3 (0.85%) cases transient supraventricular arrhythmia and in 1 (0.28%) case bradycardia to 27 bpm occurred. At 1 month: in 7 (2%) pts changes in AV conduction occurred: 1 pt (0.28%) had complete AV dissociation, 6 (1.7%) pts intermittent first degree AV block; paroxysmal atrial fibrillation (pAF) occurred in 6 (1.7%) pts, 2 of whom had pAF prior to closure. A significant increase in the number of SVE premature beats/24h was noted at 1 month after the procedure: 1167.9±409 (27–9976) compared to baseline data 60.2±44 (0–601) (p<0.0001), at 12 months the SVE number decreased to 57.2±51 (7–752) and did not differ significantly from the baseline data. There was no change in the mean number of ventricular arrhythmias/24h after the procedure. There was a significant correlation between SVE premature beats/24h at 1 month after the procedure and device size (p<0.001 r=97211). Pts with ASO device had a significantly higher number of SVE ectopy at 1 month after PFO closure (19123.9±70) compared to pts with Cardia device (811.9±324), p<0.0001. Conclusions 1. Transcatheter closure of PFO is associated with a transient increase in supraventricular premature beats and a small risk of AV conduction abnormalities and paroxysmal atrial fibrillation in the early follow-up. There is regression of periprocedural arrhythmias after 12 months of PFO closure. 2. Transcatheter closure of PFO with Cardia device is related to a lower risk of supraventricular arrhythmias in the early follow-up. 3. The smaller device is implanted the lower risk of periprocedural arrhythmias is expected.

scholarly journals Acute Hypoxic and Refractory Respiratory Failure Induced by an Underlying PFO: An Unusual Case of Platypnea Orthodeoxia and Transient Complication after Transcatheter Closure

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Carlos Salazar ◽  
Romeo A. Majano
Keyword(s):  
Respiratory Failure ◽  
Unusual Case ◽  
Transcatheter Closure ◽  
Air Embolism ◽  
Hemodynamic Instability ◽  
Foramen Ovale ◽  
St Segment Elevation ◽  
St Segment ◽  
Persistent Foramen Ovale ◽  
Pfo Closure

Platypnea orthodeoxia (PO) is an infrequent condition of dyspnea with hypoxemia, increased by adopting an upright position and is relieved in decubitus. This condition may occur in patients with hidden intracardiac shunts, usually across a persistent foramen ovale (PFO). The incidence of PFO in general population is quite common, around 27%; however, the concurrent presentation with PO, especially in acute refractory respiratory failure, is extremely rare. PFO closure in this setting is still the treatment of choice with significant improvement or complete resolution of symptoms after closure with an overall periprocedural complication in the first 24 hours of approximately less than 5%. A transient ST-segment elevation in the inferior leads is present in extremely rare occasions and most likely is induced by either an air embolism or a mechanically provoked spasm of coronary arteries. We report a case of an 83-year-old woman in acute hypoxic and refractory respiratory failure in whom PO was identified, most likely induced by a hidden PFO. The patient underwent percutaneous transcatheter closure and developed immediate chest pain, transient hemodynamic instability, and ST-segment elevation in the inferior leads; nevertheless, our patient recovered completely with rapid resolution of respiratory failure with no adverse clinical sequelae.

P6382Atrial fibrillation after closure of persistent foramen ovale in the REDUCE clinical trial

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
J E Nielsen-Kudsk ◽  
A Andersen ◽  
G Andersen ◽  
C Sjostrand ◽  
J F Rhodes ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Foramen Ovale ◽  
Persistent Foramen Ovale
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