Dr. Campbell has an excellent website
about diving medicine. This is from a recent post to his site - www.scuba-doc.com
By Ern Campbell (erncampbell@gmail.com)
Approximately 25-30% of all individuals are born with an opening between the right and left sides of their heart.
This allows, to a variable degree, the flow of deoxygenated venous blood into the arterial circulation - bypassing the filtering
effect of the lungs. Nearly all divers have varying amounts of bubbles in their venous circulation and unfiltered bubble filled
blood in the arterial circulation can cause decompression illness. Here are some studies that you might be interested in reading
about the relationship between PFO and DCS.
Int J Sports Med. 2009 Feb;30(2):150-3. Epub 2008 Sep 4.
Erratum in:
Int J Sports Med. 2009 Feb;30(2):153.
Relation
between right-to-left shunts and spinal cord decompression sickness in divers.
Gempp E, Blatteau JE, Stephant E, Louge P.
Institute of Naval Medicine, French Navy, Toulon, France. gempp@voila.fr
The role of right-to-left
shunting (RLS) in spinal cord decompression sickness (DCS) remains uncertain and could differ according to the distribution
of lesion in spinal cord with a higher risk of upper spinal cord involvement in divers presenting a large patent foramen ovale.
The aims of this study were to assess the prevalence of RLS with transcranial doppler ultrasonography in 49 divers referred
for spinal cord DCS and compare it with the prevalence of RLS in 49 diving controls, and to determine a potential relation
between RLS and lesion site of spinal cord. The proportion of large RLS was greater in DCS divers than in healthy control
divers (odds ratio, 3.6 [95 % CI, 1.3 to 9.5]; p = 0.017). Shunting was not associated with the increased incidence of cervical
spinal cord DCS (OR, 1.1 [95 % CI, 0.3 to 3.9]; p = 0.9) while a significant relationship between large RLS and spinal cord
DCS with thoracolumbar involvement was demonstrated (OR, 6.9 [95 % CI, 2.3 to 20.4]; p < 0.001). From the above results,
we conclude that the risk of spinal cord DCS in divers with hemodynamically relevant RLS is higher than in divers without
RLS, particularly in their lower localization.
PMID: 18773377 [PubMed - indexed for MEDLINE]
Related articles
· Right-to-left shunt and risk of decompression illness with cochleovestibular
and cerebral symptoms in divers: case control study in 101 consecutive dive accidents.
Crit Care Med. 2003 Jan; 31(1):84-8.
[Crit Care Med. 2003]
· Patent foramen ovale and decompression sickness in sports divers.
J Appl Physiol. 1998 May; 84(5):1622-6.
[J Appl Physiol. 1998]
· Relation between directly detected patent foramen ovale and ischemic
brain lesions in sport divers.
Ann Intern Med. 2001 Jan 2; 134(1):21-4.
[Ann Intern Med. 2001]
· ReviewClinical impact of
patent foramen ovale diagnosis with transcranial Doppler.
Eur J Ultrasound. 2002 Nov; 16(1-2):11-20.
[Eur J Ultrasound. 2002]
· Review[Patent foramen ovale:
an underrated risk for divers?]
Dtsch Med Wochenschr. 2004 Jan 2; 129(1-2):27-30.
[Dtsch Med Wochenschr. 2004]
· » See reviews... | » See all..
Read more about PFO and DCS
on these links:
1. Decompression Accidents
Part II Download pdf DCS Prevention Risks DCS Exercise and DCS DCS
and PFO References Links ... a combination of DCS and arterial gas embolism). Type I DCS
includes cutaneous manifestations
www.scuba-doc.com/dcsprbs.html
2. Patent Foramen Ovale
5 million divers (DAN, 1991) in whom the risk of DCS is about 0.05% ... in making the diagnosis of
PFO. However, it's probably not ... journal articles related to PFO that is intended
to
www.scuba-doc.com/pfo.htm
3. Chronic Neurological Adverse Effects of Diving
sport scuba divers without either DCS or PFO. We present ... the relationship between
PFO and DCS, a case-control ... higher prevalence of PFO than divers with
DCS localizations in the
www.scuba-doc.com/chrneur.htm
