PFO: Is It Time to Change the Course?

wooden pointerPresentations at SPUMS continue…

Peter Wilmshurst’s series of cases shows that 79% of all skin DCS have PFO, 10% lung disease and only remaining cases occur in divers with closed PFO due to severe dive exposure. Similar statistics were provided for inner ear DCS and neurological DCS. Other authors dispute association of PFO with spinal form of DCS  and say only cerebral DCS appears to be associated. Nevertheless, a large number of DCS cases could be avoided if the diver was aware of PFO and exercised caution.

How safe is the option of transcatheter closure?

Mark Turner, another cardiologist from the United Kingdom, provided a detailed presentation of the procedure, pitfalls and outcomes. The overall outcome: Successful with very low rate of adverse events.

Both, Wilmshurst and Turner discussed errors sometimes made in diagnosis and treatment of PFO. Different statistics floating out there may be due to inferior techniques used in detecting, sizing and closing the PFO.

What now?

If these statistics are true, it would be irresponsible not to act. These two cardiologists propose to always test if the diver suffered neurological, inner ear, skin or lymphatic DCS, but not in cases of articular and muscular pain-only bends. If a large PFO is found, the diver should either quit or close; their results justify for it. But will the high success rate remain across the wide range of doctors and hospitals? Are the existing differences only the matter of the skills and methods used or are there other factors involved?

SPUMS will discuss their position on Friday. I am looking forward to it.


Post written by: Petar Denoble, MD, D.Sc.

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