Patent foramen ovale closure in recreational divers: effect on decompression illness and ischaemic brain lesions during long-term follow-up

Journal Article

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Heart (British Cardiac Society)

Heart

Dec

1932

1937

LR: 20140730; JID: 9602087; 2011/09/13 [aheadofprint]; ppublish

England

1468-201X; 1355-6037

PMID: 21917666

eng

Journal Article; AIM; IM

10.1136/heartjnl-2011-300436 [doi]

Unknown(0)

21917666

OBJECTIVE: To test the effect of patent foramen ovale (PFO) closure on neurological events in divers. DESIGN: Prospective, non-randomised, longitudinal three-arm study. SETTING: Tertiary referral centre. POPULATION: 104 scuba divers with a history of major decompression illness (DCI). INTERVENTION: Transcutaneous PFO closure. MAIN OUTCOME MEASURES: Baseline and three follow-up examinations with a questionnaire about health status and diving habits/accidents, transoesophageal echocardiography at baseline for PFO grading, cerebral MRI at all examinations. RESULTS: 39 divers had no PFO, 26 had a PFO and chose to undergo percutaneous closure and 39 had a PFO, but decided not to undergo closure. The total number of dives, including those performed before baseline and those during long-term follow-up, was 81,654; 18,394 dives during the follow-up period of 5.3 +/- 0.3 years, during which there were a total of five major neurological DCI events-namely 0 in the no PFO group, 0.5 +/- 2.5/10(4) dives in the PFO closure group and 35.8 +/- 102.5/10(4) dives in the PFO no closure group (four events; p = 0.045 between the PFO groups). In the groups, no PFO, PFO closure and PFO no closure, there were 1.1 +/- 2.6, 0.8 +/- 1.4, 3.3 +/- 6.9 ischaemic brain lesions, respectively, at follow-up (p = 0.039 between the PFO groups)-that is, 16 +/- 42/10(4) dives in the no PFO group, 6 +/- 13/10(4) dives in the PFO closure group and 104 +/- 246/10(4) dives in the PFO no closure group (overall p = 0.042; p = 0.024 between the PFO groups). CONCLUSION: PFO closure in continuing divers appears to prevent symptomatic (major DCI) and asymptomatic (ischaemic brain lesions) neurological events during long-term follow-up.

Billinger,M., Zbinden,R., Mordasini,R., Windecker,S., Schwerzmann,M., Meier,B., Seiler,C.

Department of Cardiology, University Hospital, Bern, Switzerland.

20110913

http://vp9py7xf3h.search.serialssolutions.com/?charset=utf-8&pmid=21917666

2011