Transcatheter closure of patent foramen ovale for the secondary prevention of decompression illness in professional divers: a single-centre experience with long-term follow-up

Abstract

Background: Patent foramen ovale (PFO) with occasional right-to-left shunting is associated with an increased risk of decompression illness (DCI). Divers with a history of repetitive or severe DCI and diagnosed with PFO should be considered for transcatheter closure if they wish to continue with unrestricted diving.

Aim: To summarise our centre's experience in transcatheter PFO closure in professional divers with a history of DCI.

Methods: A follow-up of 11 consecutive divers (nine males, two females) in whom device PFO closure was performed between 2001 and 2015 was carried out by phone contact. Available medical records and diving logbooks were reviewed to determine individual DCI symptomatology, indications to the procedure, and to evaluate modifications in the diving practice.

Results: Each patient experienced at least one event of DCI before the procedure, and eight patients experienced more than one event. Total number of reported events was 62. The vast majority of events (97%) followed dives consistent with safe decompression policies. The median follow-up was 91 (minimum nine, maximum 172) months. No complications of the intervention were observed. All patients returned to unrestricted, deep diving, performing a total of 3610 dives with the median number of 225 dives (lower quartile value: 82.5 dives, upper quartile value: 725 dives). The majority of subjects dived as deep as they did before the intervention, or deeper, achieving mean maximum depth of 93.8 ± 35.6 m (vs. 89.7 ± 25.9 m before the intervention, p = 0.71). No episodes of DCI were reported during the follow-up period.

Conclusions: Transcatheter closure of PFO appears to be reasonably effective in secondary prevention of DCI associated with intra-cardiac shunting.

Keywords: decompression illness; diving; patent foramen ovale (PFO); transcatheter closure.