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JACC Cardiovasc Interv. 2014 Apr;7(4):403-8. doi: 10.1016/j.jcin.2013.12.199. Epub 2014 Mar 14.

Effect of catheter-based patent foramen ovale closure on the occurrence of arterial bubbles in scuba divers.

Author information

1
Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic.
2
Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic; Department of Neurology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
3
Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic.
4
Cardiocentrum, Hospital Podlesí, Třinec, Czech Republic.
5
Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
6
Department of Neurology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
7
Hyperbaric Chamber, Kladno Regional Hospital, Kladno, Czech Republic.
8
Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic. Electronic address: veselka.josef@seznam.cz.

Abstract

OBJECTIVES:

This study sought to evaluate the effect of catheter-based patent foramen ovale (PFO) closure on the occurrence of arterial bubbles after simulated dives.

BACKGROUND:

PFO is a risk factor of decompression sickness in divers due to paradoxical embolization of bubbles. To date, the effectiveness of catheter-based PFO closure in the reduction of arterial bubbles has not been demonstrated.

METHODS:

A total of 47 divers (age 35.4 ± 8.6 years, 81% men) with a PFO (PFO group) or treated with a catheter-based PFO closure (closure group) were enrolled in this case-controlled observational trial. All divers were examined after a simulated dive in a hyperbaric chamber: 34 divers (19 in the PFO group, 15 in the closure group) performed a dive to 18 m for 80 min, and 13 divers (8 in the PFO group, 5 in the closure group) performed a dive to 50 m for 20 min. Within 60 min after surfacing, the presence of venous and arterial bubbles was assessed by transthoracic echocardiography and transcranial color-coded sonography, respectively.

RESULTS:

After the 18-m dive, venous bubbles were detected in 74% of divers in the PFO group versus 80% in the closure group (p = 1.0), and arterial bubbles were detected in 32% versus 0%, respectively (p = 0.02). After the 50-m dive, venous bubbles were detected in 88% versus 100%, respectively (p = 1.0), and arterial bubbles were detected in 88% versus 0%, respectively (p < 0.01).

CONCLUSIONS:

No difference was observed in the occurrence of venous bubbles between the PFO and closure groups, but the catheter-based PFO closure led to complete elimination of arterial bubbles after simulated dives. (Nitrogen Bubble Detection After Simulated Dives in Divers With PFO and After PFO Closure; NCT01854281).

KEYWORDS:

catheter-based closure; decompression sickness; paradoxical embolization; patent foramen ovale

Comment in

PMID:
24630875
DOI:
10.1016/j.jcin.2013.12.199
[Indexed for MEDLINE]
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