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Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale

Sandra Rea Torti , Michael Billinger , Markus Schwerzmann , Rolf Vogel , Rainer Zbinden , Stephan Windecker , Christian Seiler
DOI: http://dx.doi.org/10.1016/j.ehj.2004.04.028 1014-1020 First published online: 2 June 2004


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 Math. 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 Math. 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.

  • Patent foramen ovale
  • Diving
  • Decompression illness
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