Lee HJ, Lim DS, Lee J, Lee DG, Oh MY, Park J, Kim CH, Jung JH, Choi RK, Kang YC. Decompression Illness in Divers With or Without Patent Foramen Ovale : A Cohort Study.
Ann Intern Med 2023. [PMID:
37429031 DOI:
10.7326/m23-0260]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND
In previous studies, the prevalence of patent foramen ovale (PFO) has been reported to be higher in scuba divers who experienced decompression illness (DCI) than in those who did not.
OBJECTIVE
To assess the association between PFO and DCI in scuba divers.
DESIGN
Prospective cohort study.
SETTING
Tertiary cardiac center in South Korea.
PARTICIPANTS
One hundred experienced divers from 13 diving organizations who did more than 50 dives per year.
MEASUREMENTS
Participants had transesophageal echocardiography with a saline bubble test to determine the presence of a PFO and were subsequently divided into high- and low-risk groups. They were followed using a self-reported questionnaire while blinded to their PFO status. All of the reported symptoms were adjudicated in a blinded manner. The primary end point of this study was PFO-related DCI. Logistic regression analysis was done to determine the odds ratio of PFO-related DCI.
RESULTS
Patent foramen ovale was seen in 68 divers (37 at high risk and 31 at low risk). Patent foramen ovale-related DCI occurred in 12 divers in the PFO group (non-PFO vs. high-risk PFO vs. low-risk PFO: 0 vs. 8.4 vs. 2.0 incidences per 10 000 person-dives; P = 0.001) during a mean follow-up of 28.7 months. Multivariable analysis showed that high-risk PFO was independently associated with an increased risk for PFO-related DCI (odds ratio, 9.34 [95% CI, 1.95 to 44.88]).
LIMITATION
The sample size was insufficient to assess the association between low-risk PFO and DCI.
CONCLUSION
High-risk PFO was associated with an increased risk for DCI in scuba divers. This finding indicates that divers with high-risk PFO are more susceptible to DCI than what has been previously reported and should consider either refraining from diving or adhering to a conservative diving protocol.
PRIMARY FUNDING SOURCE
Sejong Medical Research Institute.
Collapse