Advise Touts PFO Closure in Divers; Consultants Disagree
A new file recommends the surgical closure of patent foramen ovale in excessive-threat divers, nonetheless physicians within the US told warning about neatly-liked expend of the direction of in this population.
“PFO closure is instructed in divers with a excessive-grade PFO, with a historic previous of unprovoked decompression illness [DCS], or at the diver’s desire. Moreover safety from DCS, PFO closure moreover provides the diver existence-long safety from PFO-associated stroke,” write the authors of an analysis of the DIVE-PFO Registry.
The investigators, led by Jakub Honêk, MD, PhD, of Motol University Sanatorium in Prague, essentially based that advice on results of their analysis, which in comparison two groups of divers with excessive-grade PFO: 55 who underwent catheter-essentially based PFO closure, and 98 who were told to dive cautiously.
Over an reasonable of about 7 years, the divers who underwent catheter-essentially based PFO closure had no unprovoked decompression illness (DCS), while the location occurred in 11% of these that hadn’t had the direction of, in accordance with the file, a compare letter published online within the Journal of the American School of Cardiology.
Decompression illness, in overall called the bends, can occur as gas bubbles dash by means of the circulatory device as divers ascend. In divers with PFO, which impacts about 25% of the population, the bubbles can bypass filtration within the lungs and region off strokes, acknowledged neurologist David Thaler, MD, PhD, of Tufts Clinical Center, Boston.
PFO closure by means of surgical operation is one possibility for divers with PFO, nonetheless there is debate over whether or no longer the direction of ought to be neatly-liked. For the new compare letter, researchers prospectively tracked 748 divers within the DIVE-PFO (Decompression Illness Prevention in Divers with a Patent Foramen Ovale) registry all by means of 2006-2018. Twenty-two p.c had excessive-grade PFO.
In divers with PFO of grade 3 or above, procedures were performed if patients had a historic previous of DCS or within the event that they couldn’t adapt to conservative diving suggestions. The researchers acknowledged this population included industrial divers.
The groups that did or did no longer endure surgical operation were identical in age (40.0 and 37.3 years, respectively, P = 0.079), and sex (78.2% and 79.6% male, respectively, P = 0.893), nonetheless differed in assortment of contemporary dives (30,684 vs. 25,328, respectively, P < 0.001,), ). They were tracked for an reasonable of seven.1 years and 6.5 years, respectively.
It is no longer certain whether or no longer the divers who underwent the closure direction of had fewer DCSs due to they were more cautious about dive safety than the opposite diver team. The compare letter would no longer mention whether or no longer strokes occurred in divers within the two groups.
The observe authors write that the outcomes are in step with old findings that “PFO closure eliminates arterial gas emboli, “PFO is a necessary threat enlighten for unprovoked DCS,” and “PFO closure is a trusty direction of with a extraordinarily low complication charge.”
In interviews, physicians who are acquainted with diver safety questioned the value of the findings and acknowledged medical mavens ought to not replace divulge.
Now no longer So Snappy, Consultants Suppose
Dr. Thaler, the Tufts Clinical Center neurologist, questioned why the file explored a link between PFO and DCS. Total, he acknowledged, the findings are too incomplete to recount divulge. Anesthesiologist Richard Moon, MD, of Duke University, Durham, N.C., moreover questioned the observe’s examination of DCS. “Most DCS cases are uncorrelated with PFO. It is handiest serious cases, a minority, that might perchance conceivably be associated to PFO, and even then, many serious cases that occur in divers with PFO are unrelated to it.” He added that “comparatively a great deal of divers with comfy DCS…were mistakenly evaluated for PFO. Such divulge is unsubstantiated by data.”
May perchance well perchance merely aloof more closures be performed in this population? “I could perchance be hesitant to blueprint the instructed closures in divers,” acknowledged cardiologist David C. Peritz, MD, of Dartmouth-Hitchcock Clinical Center, Lebanon, N.H. “There are potentially different methods that you simply might perchance perchance moreover decrease your chances of getting decompression illness and blueprint your dives more trusty.”
Coronary heart specialist Clifford J. Kavinsky, MD, PhD, of Speed University Clinical Center, Chicago, acknowledged the closure direction of is “comparatively trusty” when performed by experienced surgeons. He famed that it’s far “handiest accepted to prevent recurrent ischemic stroke in patients predominantly between the ages of 18 and 60 years who comprise experienced a cortical stroke presumed to be of embolic nature and for which no evident region off might perchance moreover moreover be came upon.”
As for excessive-threat divers, he acknowledged PFO closures “might perchance moreover moreover be regarded as, nonetheless the facts as yet are no longer solid ample to strongly advocate it.”
The Czech Republic’s Ministry of Health funded the observe. The authors file no relevant disclosures. Dr. Thaler, Dr. Kavinsky, Dr. Moon and Dr. Peritz file no relevant disclosures.
SOURCE: Honěk J et al. J Am Coll Cardiol. 2020 Sep 1;76(9): 1149-50.
This article initially regarded on MDedge.com, section of the Medscape Official Network.