Patent Foramen Ovale

bendomatic · 28th September 2006, 22:05

Quote: (Originally Posted by gtzavelas)

Yes, thats an other alternative. (much nicer!)
But I am afraid (at least back in 2004 when I did my research) that the TEE is the most accurate and reliable method...
things change very fast thought so I am not a doctor anyway so cant be really sure...

Anyone has any recent info/study comparing the methods?

TEE (or TOE) is considered the gold standard. But in my case the TTE with contrast established that i did have a PFO but not its exact location, so had TOE. because of sedation to have an ultrasound probe shoved down my throat, i was unable to vasalva properly when i had the TOE performed immediately after the TTE. The TOE can be better because the probe is sitting basically right next to your heart and the ultrasound doesn't get interference from your ribs.

bendomatic · 28th September 2006, 22:35

Quote: (Originally Posted by Mdemon)

Is it painful?

The diagnosis or the procedure?

For my operation i was conscious. I was given a muscle relaxant, a powerful anticoagulant, and antibiotics prior to the procedure. During the procedure i then had an injection of iodine based contrast dye and 3 local anaesthetic injections for them to insert the device(and associated catheters and tubing) in the femoral vein, the ultrasound probe in the femoral artery. Now because of the sedation the next point i got a bit confused. One of the catheter/tubing (not sure which) was too small so they then had to insert into the other leg. And they have to leave the other in, they can't take it out because of the anticoagulant. The operation was taking longer than expected and the drugs were wearing off, i was obviously in discomfort as the nurse asked if i wanted more drugs, to which i happily agreed. My memory is blurry after that. What i do remember clearly is the sensation of the guidewire being pushed around in my heart and being able to see it on the tv screen at the same time. I thought that was cool.

Post operatively, i had to lie still for 6 hours for the anticoagulant to wear off. After about 2.5 hours my clotting rate was such that the catheters could be removed under local anaesthetic. THat was excruciating as its done with a device that can maintain pressure on the damaged blood vessels. This is a high risk time to have uncontrolled bleeding. Pressure bandages were applied. Some more antibiotics were given, to which i had an allergic type reaction of itchy skin from my scalp, down my back and welts on other areas of my body, just made my day.

The wounds were pretty sore for the next couple of days and it took weeks for the bruising to go.

pchanning · 30th September 2006, 10:49

Quote: (Originally Posted by bendomatic)

The diagnosis or the procedure?

For my operation i was conscious. I was given a muscle relaxant, a powerful anticoagulant, and antibiotics prior to the procedure. During the procedure i then had an injection of iodine based contrast dye and 3 local anaesthetic injections for them to insert the device(and associated catheters and tubing) in the femoral vein, the ultrasound probe in the femoral artery. Now because of the sedation the next point i got a bit confused. One of the catheter/tubing (not sure which) was too small so they then had to insert into the other leg. And they have to leave the other in, they can't take it out because of the anticoagulant. The operation was taking longer than expected and the drugs were wearing off, i was obviously in discomfort as the nurse asked if i wanted more drugs, to which i happily agreed. My memory is blurry after that. What i do remember clearly is the sensation of the guidewire being pushed around in my heart and being able to see it on the tv screen at the same time. I thought that was cool.

Post operatively, i had to lie still for 6 hours for the anticoagulant to wear off. After about 2.5 hours my clotting rate was such that the catheters could be removed under local anaesthetic. THat was excruciating as its done with a device that can maintain pressure on the damaged blood vessels. This is a high risk time to have uncontrolled bleeding. Pressure bandages were applied. Some more antibiotics were given, to which i had an allergic type reaction of itchy skin from my scalp, down my back and welts on other areas of my body, just made my day.

The wounds were pretty sore for the next couple of days and it took weeks for the bruising to go.

Thanks for the info Mr. Matic. Why not perform the procedure under a general anaesthetic? I think some of my friends had that.
Cheers
Paul

bendomatic · 30th September 2006, 22:55

Quote: (Originally Posted by pchanning)

Thanks for the info Mr. Matic. Why not perform the procedure under a general anaesthetic? I think some of my friends had that.
Cheers
Paul

Actually its Ms Matic

The queensland public hospital system couldn't afford to pay for the device AND the anaesthetic

I guess they figure that the risks of a general are unwarranted when the procedure can be done with light sedation and locals.

apitkin · 1st October 2006, 11:31

Quote: (Originally Posted by bendomatic)

The queensland public hospital system couldn't afford to pay for the device AND the anaesthetic

I guess they figure that the risks of a general are unwarranted when the procedure can be done with light sedation and locals.

The truth lies in between these two statements. The costs of a general anaesthetic are unwarranted.

The risks of a general anaesthetic are small compared with those of the procedure (which are also low), but a GA is sometimes used for longer procedures where the patient has to stay very still and obviously for children. The overall risks of a general anaesthetic are very low indeed.

TOE/TEE just is a way of putting the ultrasound probe closer to the bits of the heart you want to look at, therefore getting better images. A bubble-contrast study done with TOE will usually be more sensitive than one done with TTE.

Andy

pchanning · 14th April 2007, 11:12

Quote: (Originally Posted by pchanning)

I have just found out that I am one of the 30% of the population that have a PFO. I sufferred 'significant neurological DCS' some 3 months ago (in short, properly f****d up) and the wondering/ lack of a decent explanation has been unsettling. Strange, I am actually quite relieved.

What I really want to say is this: after decompression dives not only should one refrain from straining with equipment and generally take it easy, one should also not sneeze, cough or even strain on the loo - all these things increase thorassic pressure and can manifest a neuro bend if one has a PFO (which makes perfect sense, but eluded me until too late). Seriously, I suffered mine due to coughing, albeit violently, and it manifest in about 3 minutes - then I hit the floor!

I was surprised that the PFO did not reveal itself some time ago, but surprisingly this is not uncommon.

Incidentally, I am due to be assessed at DDRC (Diving Deseases Research Centre) next week, which should be interesting (a friend of mine has recently been given a 10m depth limit due to the presence of a PFO). So it seems I am going to look rather overdressed in 10m of water - with all the snorkellers.

WORTHY PLUG: I found the new Edition of Deeper into Diving (John Lippmann and Dr. Simon Mitchell - whom we are very lucky to have on this board) to be a very useful and also comforting resource. Thanks to you both for all the hard work. Go an buy a copy if you don't have one already, it is simply excellent with a wealth of up to date information - the likes of which are better to learn, rather than glean from experience.

Take it easy - and no running, lifting, farting, sneezing or coughing.

Cheers
Paul Channing

I had my pfo closed yesterday. Today I am up and about, took a shower, had a walk. Everything went smoothly and the mental relief is quite something. It really is amazing what they can do these days. Please get yourselves checked out. It is a really good way of spending a few hundred quid... trust me!

Mdemon · 14th April 2007, 13:50

Great news mate! How long til you can get wet? (Now you are UNBENDABLE!!!!!!!!

)

Phil Ennis · 14th April 2007, 15:51

Hello Paul,
Met you at Brum dive show walking in with John and Helen. I had mine closed on the 7th of last month, 9mm hole and all seems well. I am just waiting for an appointment to go back for another bubble check with Dr Wilmshurst to see whether it has closed.

Good luck.

Andre · 15th April 2007, 00:35

Just get out of the decompression chamber in Toulouse France. 8 Hours comex. I was told told by my doc two years ago that my foramen ovale is closed 100%. Now the the doc in duty told my that this can chance any time.

apitkin · 15th April 2007, 08:05

Quote: (Originally Posted by Mdemon)

Great news mate! How long til you can get wet? (Now you are UNBENDABLE!!!!!!!!

)

Quote: (Originally Posted by Andre)

Just get out of the decompression chamber in Toulouse France. 8 Hours comex. I was told told by my doc two years ago that my foramen ovale is closed 100%. Now the the doc in duty told my that this can chance any time.

Please be careful out there. There is no hard evidence whatsoever that closing a PFO reduces your DCI risk. The evidence that it has little or no effect is slightly more convincing.

Andy

28th September 2006, 22:05	#31 (permalink)
bendomatic it's a girl due 20th May Current Rebreather/s: Sport Kiss Other Rebreather/s: Join Date: Apr 2005 Location: Brisbane Australia Posts: 198	Re: Patent Foramen Ovale Quote: (Originally Posted by gtzavelas) Yes, thats an other alternative. (much nicer!) But I am afraid (at least back in 2004 when I did my research) that the TEE is the most accurate and reliable method... things change very fast thought so I am not a doctor anyway so cant be really sure... Anyone has any recent info/study comparing the methods? TEE (or TOE) is considered the gold standard. But in my case the TTE with contrast established that i did have a PFO but not its exact location, so had TOE. because of sedation to have an ultrasound probe shoved down my throat, i was unable to vasalva properly when i had the TOE performed immediately after the TTE. The TOE can be better because the probe is sitting basically right next to your heart and the ultrasound doesn't get interference from your ribs. __________________ why deal with idiots on the net when you have to spend all day dealing with them at work. Last edited by bendomatic : 28th September 2006 at 22:07. Reason: what i wrote just seemed harsh when it wasn't intended
(Online)

28th September 2006, 22:35	#32 (permalink)
bendomatic it's a girl due 20th May Current Rebreather/s: Sport Kiss Other Rebreather/s: Join Date: Apr 2005 Location: Brisbane Australia Posts: 198	Re: Patent Foramen Ovale Quote: (Originally Posted by Mdemon) Is it painful? The diagnosis or the procedure? For my operation i was conscious. I was given a muscle relaxant, a powerful anticoagulant, and antibiotics prior to the procedure. During the procedure i then had an injection of iodine based contrast dye and 3 local anaesthetic injections for them to insert the device(and associated catheters and tubing) in the femoral vein, the ultrasound probe in the femoral artery. Now because of the sedation the next point i got a bit confused. One of the catheter/tubing (not sure which) was too small so they then had to insert into the other leg. And they have to leave the other in, they can't take it out because of the anticoagulant. The operation was taking longer than expected and the drugs were wearing off, i was obviously in discomfort as the nurse asked if i wanted more drugs, to which i happily agreed. My memory is blurry after that. What i do remember clearly is the sensation of the guidewire being pushed around in my heart and being able to see it on the tv screen at the same time. I thought that was cool. Post operatively, i had to lie still for 6 hours for the anticoagulant to wear off. After about 2.5 hours my clotting rate was such that the catheters could be removed under local anaesthetic. THat was excruciating as its done with a device that can maintain pressure on the damaged blood vessels. This is a high risk time to have uncontrolled bleeding. Pressure bandages were applied. Some more antibiotics were given, to which i had an allergic type reaction of itchy skin from my scalp, down my back and welts on other areas of my body, just made my day. The wounds were pretty sore for the next couple of days and it took weeks for the bruising to go. __________________ why deal with idiots on the net when you have to spend all day dealing with them at work.
(Online)

30th September 2006, 10:49	#33 (permalink)
pchanning PFO free :) Current Rebreather/s: Inspiration Classic Other Rebreather/s: Join Date: Feb 2005 Location: fixed! Posts: 454	Re: Patent Foramen Ovale Quote: (Originally Posted by bendomatic) The diagnosis or the procedure? For my operation i was conscious. I was given a muscle relaxant, a powerful anticoagulant, and antibiotics prior to the procedure. During the procedure i then had an injection of iodine based contrast dye and 3 local anaesthetic injections for them to insert the device(and associated catheters and tubing) in the femoral vein, the ultrasound probe in the femoral artery. Now because of the sedation the next point i got a bit confused. One of the catheter/tubing (not sure which) was too small so they then had to insert into the other leg. And they have to leave the other in, they can't take it out because of the anticoagulant. The operation was taking longer than expected and the drugs were wearing off, i was obviously in discomfort as the nurse asked if i wanted more drugs, to which i happily agreed. My memory is blurry after that. What i do remember clearly is the sensation of the guidewire being pushed around in my heart and being able to see it on the tv screen at the same time. I thought that was cool. Post operatively, i had to lie still for 6 hours for the anticoagulant to wear off. After about 2.5 hours my clotting rate was such that the catheters could be removed under local anaesthetic. THat was excruciating as its done with a device that can maintain pressure on the damaged blood vessels. This is a high risk time to have uncontrolled bleeding. Pressure bandages were applied. Some more antibiotics were given, to which i had an allergic type reaction of itchy skin from my scalp, down my back and welts on other areas of my body, just made my day. The wounds were pretty sore for the next couple of days and it took weeks for the bruising to go. Thanks for the info Mr. Matic. Why not perform the procedure under a general anaesthetic? I think some of my friends had that. Cheers Paul __________________ Cheers Paul The key to enlightenment... is survival.
(Offline)

30th September 2006, 22:55	#34 (permalink)
bendomatic it's a girl due 20th May Current Rebreather/s: Sport Kiss Other Rebreather/s: Join Date: Apr 2005 Location: Brisbane Australia Posts: 198	Re: Patent Foramen Ovale Quote: (Originally Posted by pchanning) Thanks for the info Mr. Matic. Why not perform the procedure under a general anaesthetic? I think some of my friends had that. Cheers Paul Actually its Ms Matic The queensland public hospital system couldn't afford to pay for the device AND the anaesthetic I guess they figure that the risks of a general are unwarranted when the procedure can be done with light sedation and locals. __________________ why deal with idiots on the net when you have to spend all day dealing with them at work.
(Online)

1st October 2006, 11:31	#35 (permalink)
apitkin New Member Current Rebreather/s: Prism Topaz Other Rebreather/s: Join Date: Feb 2005 Location: Cloud Cuckoo Land Posts: 97	Re: Patent Foramen Ovale Quote: (Originally Posted by bendomatic) The queensland public hospital system couldn't afford to pay for the device AND the anaesthetic I guess they figure that the risks of a general are unwarranted when the procedure can be done with light sedation and locals. The truth lies in between these two statements. The costs of a general anaesthetic are unwarranted. The risks of a general anaesthetic are small compared with those of the procedure (which are also low), but a GA is sometimes used for longer procedures where the patient has to stay very still and obviously for children. The overall risks of a general anaesthetic are very low indeed. TOE/TEE just is a way of putting the ultrasound probe closer to the bits of the heart you want to look at, therefore getting better images. A bubble-contrast study done with TOE will usually be more sensitive than one done with TTE. Andy
(Offline)

14th April 2007, 11:12	#36 (permalink)
pchanning PFO free :) Current Rebreather/s: Inspiration Classic Other Rebreather/s: Join Date: Feb 2005 Location: fixed! Posts: 454	Re: Patent Foramen Ovale Quote: (Originally Posted by pchanning) I have just found out that I am one of the 30% of the population that have a PFO. I sufferred 'significant neurological DCS' some 3 months ago (in short, properly f**d up) and the wondering/ lack of a decent explanation has been unsettling. Strange, I am actually quite relieved. What I really want to say is this: after decompression dives not only should one refrain from straining with equipment and generally take it easy, one should also not sneeze, cough or even strain on the loo - all these things increase thorassic pressure and can manifest a neuro bend if one has a PFO (which makes perfect sense, but eluded me until too late). Seriously, I suffered mine due to coughing, albeit violently, and it manifest in about 3 minutes - then I hit the floor! I was surprised that the PFO did not reveal itself some time ago, but surprisingly this is not uncommon. Incidentally, I am due to be assessed at DDRC (Diving Deseases Research Centre) next week, which should be interesting (a friend of mine has recently been given a 10m depth limit due to the presence of a PFO). So it seems I am going to look rather overdressed in 10m of water - with all the snorkellers. WORTHY PLUG: I found the new Edition of Deeper into Diving** (John Lippmann and Dr. Simon Mitchell - whom we are very lucky to have on this board) to be a very useful and also comforting resource. Thanks to you both for all the hard work. Go an buy a copy if you don't have one already, it is simply excellent with a wealth of up to date information - the likes of which are better to learn, rather than glean from experience. Take it easy - and no running, lifting, farting, sneezing or coughing. Cheers Paul Channing I had my pfo closed yesterday. Today I am up and about, took a shower, had a walk. Everything went smoothly and the mental relief is quite something. It really is amazing what they can do these days. Please get yourselves checked out. It is a really good way of spending a few hundred quid... trust me! __________________ Cheers Paul The key to enlightenment... is survival.
(Offline)

14th April 2007, 13:50	#37 (permalink)
Mdemon SiegeEngine II Current Rebreather/s: Inspiration Classic Home Build Other Rebreather/s: Inspiration Classic Home Build Join Date: Feb 2007 Location: SWUK Posts: 1,866	Re: Patent Foramen Ovale Great news mate! How long til you can get wet? (Now you are UNBENDABLE!!!!!!!! )
(Offline)

14th April 2007, 15:51	#38 (permalink)
Phil Ennis New Member Current Rebreather/s: Inspiration Classic Other Rebreather/s: Join Date: Jul 2005 Location: Windermere, Cumbria. Posts: 72	Re: Patent Foramen Ovale Hello Paul, Met you at Brum dive show walking in with John and Helen. I had mine closed on the 7th of last month, 9mm hole and all seems well. I am just waiting for an appointment to go back for another bubble check with Dr Wilmshurst to see whether it has closed. Good luck. __________________ Phil Ennis. My Website
(Offline)

15th April 2007, 00:35	#39 (permalink)
Andre New Member Current Rebreather/s: Classic Kiss Other Rebreather/s: Join Date: Jun 2005 Location: Switzerland, Aarau Posts: 132	Re: Patent Foramen Ovale Just get out of the decompression chamber in Toulouse France. 8 Hours comex. I was told told by my doc two years ago that my foramen ovale is closed 100%. Now the the doc in duty told my that this can chance any time.
(Offline)

15th April 2007, 08:05	#40 (permalink)
apitkin New Member Current Rebreather/s: Prism Topaz Other Rebreather/s: Join Date: Feb 2005 Location: Cloud Cuckoo Land Posts: 97	Re: Patent Foramen Ovale Quote: (Originally Posted by Mdemon) Great news mate! How long til you can get wet? (Now you are UNBENDABLE!!!!!!!! ) Quote: (Originally Posted by Andre) Just get out of the decompression chamber in Toulouse France. 8 Hours comex. I was told told by my doc two years ago that my foramen ovale is closed 100%. Now the the doc in duty told my that this can chance any time. Please be careful out there. There is no hard evidence whatsoever that closing a PFO reduces your DCI risk. The evidence that it has little or no effect is slightly more convincing. Andy
(Offline)

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