Jakub Honěk1, Martin Srámek2, Luděk Sefc3, Jaroslav Januška4, Jiří Fiedler5, Martin Horváth5, Aleš Tomek6, Stěpán Novotný7, Tomáš Honěk5, Josef Veselka8. 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).
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).
Authors: Björn Edvinsson; Ulf Thilén; Niels Erik Nielsen; Christina Christersson; Mikael Dellborg; Peter Eriksson; Joanna Hlebowicz Journal: Diving Hyperb Med Date: 2021-03-31 Impact factor: 0.887