Alex Pearman1, Luc Bugeja2, Martin Nelson2, Gergely V Szantho2, Mark Turner3. 1. Medical School, University of Bristol, Bristol, UK. 2. Bristol Heart Institute, Bristol Royal Infi rmary, Bristol, UK. 3. Level 7 Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street , Bristol BS2 8HW, UK, E-mail: markturner3@nhs.net.
Abstract
INTRODUCTION: Right-to-left shunt across a persistent foramen ovale (PFO) has been associated with cutaneous, neurological and vestibular decompression illness (DCI). Percutaneous closure of a PFO has been used to reduce the risk of DCI. There are no randomised controlled trial data to support PFO closure for the prevention of decompression illness (DCI), so the need for audit data on the safety and efficacy of this technique has been recognised by the National Institute of Health and Clinical Excellence in the UK. METHOD: Retrospective audit of all transcatheter PFO closures to reduce the risk of DCI performed by a single cardiologist with an interest in diving medicine. RESULTS: A total of 105 eligible divers undergoing 107 procedures was identified. There was a low rate of procedural complications; a rate lower than a recent randomised trial of PFO closure for stroke. Atrial fibrillation required treatment in two patients. One patient with a previously repaired mitral valve had a stroke that was thought to be unrelated to the PFO closure. Sixteen divers had minor post-procedure symptoms not requiring any treatment. Two divers required a second procedure because of residual shunt; both subsequently returned to unrestricted diving. Eighty-one of 95 divers in whom follow-up bubble contrast echocardiography was available returned to unrestricted diving. CONCLUSIONS: The PFO closure procedure appeared to be safe and was associated with the majority of divers being able to successfully return to unrestricted diving.
INTRODUCTION: Right-to-left shunt across a persistent foramen ovale (PFO) has been associated with cutaneous, neurological and vestibular decompression illness (DCI). Percutaneous closure of a PFO has been used to reduce the risk of DCI. There are no randomised controlled trial data to support PFO closure for the prevention of decompression illness (DCI), so the need for audit data on the safety and efficacy of this technique has been recognised by the National Institute of Health and Clinical Excellence in the UK. METHOD: Retrospective audit of all transcatheter PFO closures to reduce the risk of DCI performed by a single cardiologist with an interest in diving medicine. RESULTS: A total of 105 eligible divers undergoing 107 procedures was identified. There was a low rate of procedural complications; a rate lower than a recent randomised trial of PFO closure for stroke. Atrial fibrillation required treatment in two patients. One patient with a previously repaired mitral valve had a stroke that was thought to be unrelated to the PFO closure. Sixteen divers had minor post-procedure symptoms not requiring any treatment. Two divers required a second procedure because of residual shunt; both subsequently returned to unrestricted diving. Eighty-one of 95 divers in whom follow-up bubble contrast echocardiography was available returned to unrestricted diving. CONCLUSIONS: The PFO closure procedure appeared to be safe and was associated with the majority of divers being able to successfully return to unrestricted diving.