Author + information
- Received October 10, 2013
- Revision received November 29, 2013
- Accepted December 17, 2013
- Published online April 1, 2014.
- Jakub Honěk, MD∗,†,
- Martin Šrámek, MD†,‡,
- Luděk Šefc, PhD†,
- Jaroslav Januška, MD§,
- Jiří Fiedler, MD∗,
- Martin Horváth, MD∗,
- Aleš Tomek, MD‡,
- Štěpán Novotný, MD‖,
- Tomáš Honěk, MD, PhD∗ and
- Josef Veselka, MD, PhD∗∗ ()
- ∗Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- †Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
- ‡Department of Neurology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- §Cardiocentrum, Hospital Podlesí, Třinec, Czech Republic
- ‖Hyperbaric Chamber, Kladno Regional Hospital, Kladno, Czech Republic
- ↵∗Reprint requests and correspondence:
Dr. Josef Veselka, Department of Cardiology, Motol University Hospital, V Úvalu 84, 150 06, Praha 5, Czech Republic.
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. (Nitrogen Bubble Detection After Simulated Dives in Divers With PFO and After PFO Closure; NCT01854281)
This study was supported by the following grants: #MH CZ–DRO 00064203 from the University Hospital Motol; #SVV-2013-266509 from the Charles University; and #PRVOUK-P24/LF1/3 of the Charles University–First Faculty of Medicine. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 10, 2013.
- Revision received November 29, 2013.
- Accepted December 17, 2013.
- American College of Cardiology Foundation