Copyright © 2004 by the European Society of Cardiology.
Clinical research
Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale
Department of Cardiology, University Hospital, CH-3010 Bern, Switzerland
Received November 29, 2003;
revised April 9, 2004;
accepted April 13, 2004
* Corresponding author. Tel.: +41-31-632-36-93; fax: +41-31-632-42-99
E-mail address: christian.seiler.cardio{at}insel.ch
Background The risk of developing decompression illness (DCI) in divers with a patent foramen ovale (PFO) has not been directly determined so far; neither has it been assessed in relation to the PFO's size.
Methods In 230 scuba divers (age 39±8 years), contrast trans-oesophageal echocardiography (TEE) was performed for the detection and size grading (0–3) of PFO. Prior to TEE, the study individuals answered a detailed questionnaire about their health status and about their diving habits and accidents. For inclusion into the study, 
200 dives and strict adherence to decompression tables were required.
Results Sixty-three divers (27%) had a PFO. Overall, the absolute risk of suffering a DCI event was 2.5 per 104 dives. There were 18 divers (29%) with, and 10 divers (6%) without, PFO who had experienced 1 major DCI events 
. In the group with PFO, the incidence per 104 dives of a major DCI, a DCI lasting longer than 24 h and of being treated in a decompression chamber amounted to 5.1 (median 0, interquartile range [IQR] 0–10.0), 1.9 (median 0, IQR 0–4.0) and 3.6 (median 0, IQR 0–9.8), respectively and was 4.8–12.9-fold higher than in the group without PFO 
. The risk of suffering a major DCI, of a DCI lasting longer than 24 h and of being treated by recompression increased with rising PFO size.
Conclusion The presence of a PFO is related to a low absolute risk of suffering five major DCI events per 104 dives, the odds of which is five times as high as in divers without PFO. The risk of suffering a major DCI parallels PFO size.
Key Words: Patent foramen ovale • Diving • Decompression illness
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