Does endoscopic PFO closure reduce arterial bubbles? You bet your bippy.+

[DocVikingo]

“JACC Cardiovasc Interv. 2014 Mar 13. [Epub ahead of print]

Effect of Catheter-Based Patent Foramen Ovale Closure on the Occurrence of Arterial Bubbles in Scuba Divers.

Honěk J1, Srámek M2, Sefc L3, Januška J4, Fiedler J5, Horváth M5, Tomek A6, Novotný S7, Honěk T5, Veselka J8.

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. &#8220;

 

[TSandM]

Makes sense; I'm not surprised.

 

[cmarkham5]

so glad i got mine closed... was a piece of cake really.

 

[DocVikingo]

... was a piece of cake really.

But did it rise without inert gas bubbles?

Sorrry.

Cheers, DocV

 

[Diver0001]

so glad i got mine closed... was a piece of cake really.

How were you diagnosed?

R..

 

[cmarkham5]

How were you diagnosed?

R..

Oddly before I decided to dive... i had been seeing my cardiologist for extreme PVC's. I was very tired. Migraines. and could not tolerate exercise. Being only 34 i found that to be unacceptable. She put me on medication and that seemed to help. I wanted to become a diver with my husband. Our first pool session i had to quit i became too tired and just was not feeling quite right. my chest hurt my head reeled into a migraine. My dad asked me about my cardiologist and said i needed to get clearance from her and get checked out. Smart man he is said in fact "are you sure you dont have a hole in your heart?". i thought surely they would have told me about that by now with all the tests i had done. Off i went back to my dr. i told her everything and that i wanted to become a diver. She said well if you want to dive i insist we do a bubble study. shortly after my bubble she called me and said DO NOT GO DIVING> come over to my office (i work on the same campus as her) and i will show you and explain to you what we found. My heart was shunting majorly. it was not a few bubbles but rather flooding through a big hole. She was not sure how this had not been found before and why i was not MORE symptomatic from it. she said i know you want to dive but you cant like this. or at least she wouldnt recommend or clear me for it. she suggested i speak to another dr who did a procedure to close it. So i spoke with him and did my research. i told her i wanted to close it. they ended up using the biggest plug they had and the procedure was easy. the tough part was laying flat for hours on end. bleh! misery.

after the procedure i cant really explain it other than waking up the next day to go home from the hospital i FELT better. more clear headed, energy, etc. and i know migraines are not proven to be linked but i was having them twice a week.. i no longer have them at all.

i was given the green light to dive after some waiting time to heal. echo shows it is well sealed. I signed up for Dr. Denoble's study as well.

 

[Diver0001]

Oddly before I decided to dive... i had been seeing my cardiologist for extreme PVC's.

Extreme PVC's? Sounds like "big plastic pipes" to me. What is that?

My sister had a lot of those symptoms too and it turned out to be WPW. Sounds like you got lucky to get a correct diagnosis. I bet a lot of people don't.

R..

 

[uncfnp]

Extreme PVC's? Sounds like "big plastic pipes" to me. What is that?

My sister had a lot of those symptoms too and it turned out to be WPW. Sounds like you got lucky to get a correct diagnosis. I bet a lot of people don't.

R..

Contrary to the obvious, PVC in medical lingo stands for Premature Ventricular Contraction. It is an abnormal heart beat. A few here and there are not particular worrisome but when you string them together it's call Ventricular Tachycardia and hopefully someone nearby will yell "call 911" and grab an AED!

 

[TSandM]

PVC stands for premature ventricular contraction. If you've ever felt your heart skip a beat and then "thump" you may have had one. Some people have a LOT of them, and there are criteria for how many and of what configuration will trigger a more extensive workup. Cmarkham had some good docs; a lot would have blown her symptoms off.

 

[Diver0001]

If you've ever felt your heart skip a beat and then "thump" you may have had one.

Ah... the feeling of being in love ... LOL

I had a period of extreme stress with months of weird rhythm problems some years ago. They called it "sinus tachycardia". It was weird as hell...like my heart and the rest of my body were not connected to the same reality anymore.

I think it happened because I was mentally and physically exhausted. In some ways it was a permanent injury. I don't think I'll ever be able to run my mental engine that hot again. I've become a lot more easy-going because of it but all of my A-type dreams have been shattered. I've become a lot more "average" than I ever wanted to be.

R..