PFO Video

rogeringebo

Is it possible for me to know if I have it or can it only be detected by a doctor?...I have done more than 1000 dives and quite a few were decodives...Should I have noticed by now?
Best
Rodge

apitkin

Unfortunately not. There are lots of cases where divers have been diving for years without problems, get bent, are then tested and found to have a large interatrial shunt.

The bubble-contrast echocardiogram is the simplest way to test for a PFO. You cannot detect it on physical examination with a stethoscope unless you happen have an ASD (atrial septal defect), a congenital defect that results in a hole in the atrial septum that is continuously wide open, rather than intermittently like a PFO. Even then the signs are subtle and easily missed, even by a cardiologist, let alone the average GP.

We are always coming up against the issue of how much a commonly-occurring lesion (almost a normal anatomical variant) influences the incidence of a rare event (DCI). When assessed with proper statistical methods it turns out that very large studies would be required to answer the question with any degree of certainty that would be useful.

Andy

Pelagian

Thnaks Simon that helps

Seb

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Marvintpa

The information above is correct, the estimate is up to 30% of people have a PFO and don't know it. You can do thousands of dives with one and never know it because some only open when provoked. What constitutes "provoked"? Can be something as simple as breathing or a val salva, or more involved like lifting or pulling something - something which creates back pressure. My GF suffered a couple of "unexplained" type 1 hits and went to be tested. The test was going along fine and nothing was found until the end when he said "Now cough", and the PFO opened and the bubbles shot across.

Simon Mitchell

Hi Marvin,

Not doubting the validity of your story for one moment, but just by way of clarification....

There has been no demonstration of a relationship between PFO and "Type 1" DCS (that is, presentation with pain as the only symptom). It is highly likely that the PFO had nothing to do with these episodes. After all, as you point out, there was a (roughly) 30% of the test being positive whether the diver had suffered DCS or not.

Regards,

Simon M

Nick uk.

Better the devil you know, than the devil you don't...

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andibk

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I just got my PFO tested the other day and glad to say that I do not have one. That was the best news and glad that I do not have to have that test again. From what I understand there are a couple of ways to get tested, hopefully the other way is better then the way I got tested. The doctors did a good job themselves but I was not so enthused with having a hose the size of a garden hose shoved down my throat. It was a uncomfortable feeling, making you want to throw up and such. One of the nurses could not speak such good english and asked the other lady what does the word F@#%^ mean. I guess I said that word a couple of times as the tube was being inserted. Cedric filmed the treatment that I did and is looking at another way of having it tested. I will go when he gets his down and will let you know which way to get it done.

andibk

cedricverdier

Bruce had his PFO tested by TEE (echocardiogram). According to some cardiologists in Thailand, it looks like MRI is also a very reliable way to test for a PFO.. and a much nicer technique . If it's proved to be true, I'll rather go that way. It costs roughly the same and I don't like "the garden hose in my throat".

Cheers

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Trimix (CCR and OC) and Cave Diving Instructor Trainer

www.CedricVerdier.com
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vlada

Simon, the DCS episodes that Marvintpa referred to were not Type 1s but rather skin bends. In the last case, I discovered some minor loss of function in both arms couple of days after skin rash on both shoulders was treated with O2/advil and disappeared. My dive doc told me that i likely had DCS2 that went undiagnosed becasue i never went to a chamber.
Vlada (Marvintpa's GF)

Simon Mitchell

Hi Vlada,

Thanks. This is a very different situation. Peter Wilmshurst has published a study showing a strong link between cutaneous DCS and PFO (particularly large PFOs that readily shunt from right to left). It is certainly possible that your DCS episodes were linked to the PFO. It is fascinating to speculate on why shunted venous nitrogen bubbles are likely to cause cutaneous symptoms but I won't get into that here.

By the way, from what I have seen on other sites you and Marvin take some outstanding underwater photos!

Simon M.