Patent foramen ovale and decompression sickness
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [3]
Overview
Decompression illness is associated with a 5 to 13 fold increased incidence of a patent foramen ovale. The risk increases with an increase in defect size. Device closure can be considered in divers with unexplained decompression illness, especially those who wish to continue diving [1].
Decompression sickness in patent foramen ovale
Decompression illness can occur in divers as they ascend from deeper waters to the surface. The change in pressure (from high to low) causes gas bubbles to form in the bloodstream. The gas bubbles come from inert gases like nitrogen. These gases are present in the different parts of the body like joints, spine and skin pores. If nitrogen is forced to come out of solution too quickly, bubbles form in parts of the body causing the signs and symptoms of the "bends". Signs and symptoms of the bends include itching skin and the development of rashes, joint pain, sensory system failure, paralysis, and death. These gas bubbles can enter the venous system and can enter the systemic circulation via inter-atrial communications such as a patent foramen ovale or an atrial septal defect. This paradoxical embolism or right-to left shunt can in turn be associated with complications such as ischemic brain injury (TIA or stroke.
Trial supportive data
In a study done on 230 scuba divers, the incidence of patent foramen ovale was found to be 23%. The incidence of significant decompression illness was found to be approximately 5 to 13-fold increased in divers with patent foramen ovale compared to those without a defect. Additionally, the risk of a decompression illness was positively associated with defect size. It was also shown that the number of ischemic brain lesions were twice as common with presence of patent foramen ovale than without it. Thus, device closure should be considered in divers with unexplained decompression illness[1].
References
- ↑ 1.0 1.1 Torti SR, Billinger M, Schwerzmann M, Vogel R, Zbinden R, Windecker S; et al. (2004). "Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale". Eur Heart J. 25 (12): 1014–20. doi:10.1016/j.ehj.2004.04.028. PMID 15191771.