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Thread: PFO possible occluder failure

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    RBW Member Dive Sprite will become famous soon enough Dive Sprite will become famous soon enough Dive Sprite will become famous soon enough Dive Sprite's Avatar
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    Dyson

    PFO possible occluder failure

    After a series of skin bends resulting in a very severe one with lymphatic complications, I had a large PFO diagnosed and fixed in 2008 with a collagen occluder (BioStar).

    Diving this weekend I suffered a painful and obvious skin bend with a very sore chest and slight breathing difficulties. Got put in the chamber for five hours and not much difference felt, but its all easing off now - and I feel OK.

    My concern is, could the occluder have 'failed'?

    I am activly seeking a referral to a cariologist now to get the answer (it will be at least a couple of weeks before I can get a TOE test), but do any of the docs here know if statistics are available for the likelihood of failure, and what the course of action is if this is the case?

    Anyone else suffered continuing Skin Bends post PFO closure?
    Anyone else had a 'BioStar' collagen occluder fitted and suffered issues?

    Dive information:
    Where:UK
    Depth: 72m
    Bottom time: 20mins
    Run time: 77 mins
    Inspiration Vision running 10/52 Diluent.
    GF: 15 / 85
    Warm and comfortable in a Dry suit
    Age: 44 years
    No other limiting factors

    I'm a bit worried that this might mean I need to hang up my fins... Wife is already planning what to do with the money saved by me not diving any more...

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    Re: PFO possible occluder failure

    Quote Originally Posted by Dive Sprite  View Original Post
    Dive information:
    Where:UK
    Depth: 72m
    Bottom time: 20mins
    Run time: 77 mins
    Inspiration Vision running 10/52 Diluent.
    GF: 15 / 85
    Warm and comfortable in a Dry suit
    Age: 44 years
    No other limiting factors

    I'm a bit worried that this might mean I need to hang up my fins... Wife is already planning what to do with the money saved by me not diving any more...
    For the record, I did a profile in V-planner at 20mins@72m on +3, and it gave the same runtime, +5 give 7mins more deco - hardly earth-shattering. So the profile at first glance seems conservative.

    Hope you get some answers.

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    Re: PFO possible occluder failure

    Quote Originally Posted by Dive Sprite  View Original Post
    Anyone else suffered continuing Skin Bends post PFO closure?
    Yes...,

    I dive extremely conservatively, GF of 25/65, I hand up my bottles, ascent from last stop is Molasses slow, and I take the ladder VERY slowly and orderly.

    I hydrate continuously on the boat before and after, and slowly walk to the car afterwards.

    I'm fortunately to dive in warm water, so extending 15-30 extra minutes is fine for everyone but the Captain waiting topside.

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    Re: PFO possible occluder failure

    DAN's Alert Diver Mag just ran an article on PFO's & Decompression Issues.

    You may want to give it a read...

    Alert Diver Online

    Richie

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    Re: PFO possible occluder failure

    just interested to know if you ever had confirmed that it was occluding properly after the operation? like at 3 months post op? anecdotally (!), i know of only one failure but that was at the time of initial implantation and that was known pretty much straight away that it was never going to heal properly due to positional issues (pretty sure it was an amplatzer but don't quote me, it was 5+ years ago now). I for instance still get infrequent migraine visual auras, so my PFO occlusion (amplatzer) hasn't helped me in that department. i haven't got the bends since: most of my diving for the first two years afterwards was all trimix, decompression dives in teh range of 40-70m without problem, but i haven't dived terribly much in the last few years due to small child.

    just remember that PFO occlusion doesn't make you unbendable, and there is a lot that we don't understand about the mechanism of bubble formation in the body and the effects thereof. good luck with your medical investigations.

    rachel
    Last edited by bendomatic; 7th June 2010 at 22:12.

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    Re: PFO possible occluder failure

    As you know decompression sickeness is not an exact science. A PFO is just one risk factor for DCS and not necessarily "cause-and-effect". Lots of people get bent for "no good reason" without PFO so it is not unreasonable to have an undeserved DCS event even after having a PFO closed. It is unlikely that the closure "failed" though there are occasionally residual shunts after closure procedures so it is reasonable to have another echo to check it out. The best approach is to dive conservatively -- like Tim's post above. Just my 2 cents as a tech diving cardiologist who spends his days closing PFOs! :)

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    Dyson

    Re: PFO possible occluder failure

    Many thanks for the really excellent responses.

    I totally agree that having a PFO closure wont make me un-bendable, and that diving conservatively is the best approach after any DCI or PFO closure. It is something I try to practice, but since my OP in 2008 I've had no recurrent problems. Perhaps I lost sight of the need for added conservatism in that time...

    I had a retest after 3 months post operation - and passed, all clear.

    My understanding is that Skin Bends in particular are indications of PFO, almost guaranteed.

    On this occasion the bend manifested itself upon surfacing (before getting back onto the boat) with a burning sensation - like scolding coffee poured over the upper chest area. I've never had that before and it was quite painful. This made me think something seriously bad happened that might involve the implant. Of course it might be something totally new, and it might be down to doing a 72m dive with helium, middle-age and rolling of dice...

    I will be getting a re-test asap, and will let you know if there are any interesting results to report.

    Hopefully this is simply my turn again, and there is nothing odd going on with the implant. Hopefully I just need to get more conservative and dont need to worry about the old ticker.

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    Re: PFO possible occluder failure

    I got a skin bend last year after a pretty uneventful dive & spent 5 hours very uneventful hours in the pot afterwards..
    I was told at the time that, as it was unexplained bend (I'd not missed any stops etc) I would probably find out I had a PFO. So I went and got tested only to find out I did NOT have a PFO - I'd just been unlucky.
    When I went for my test we spoke to a few other divers who were also waiting to see the Cardiologist. I seam to remember one of them having a similar problem of having a large hole fixed then going diving and having complications & she had found out she had another smaller hole (which had gone previously undiagnosed) which she was having fixed when we spoke to her in the hospital.

    Hope this helps,
    Simon

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    Re: PFO possible occluder failure

    The failure of closure rate is quoted as being between 2 and 5%. Most of those who 'fail' to close will result in at least a significant reduction of the shunt. Dont forget that even in those people who have a PFO, it may well NOT be the only point of shunting.

    Most cardiologists will organise a transthoracic bubble test about three months after the device is placed. If it is not shut at that time, then you may have another test 3-6 months later.

    There are no certainties with this procedure. Even if it appears 'closed' you may be getting intermittent leakage particularly after heavy exercise.

    the real question, of course, is whether to continue to undertake dives of the magnitude you have outlined if the shunt is present but reduced.

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    RBW Member humpbackdiving is an unknown quantity at this point humpbackdiving's Avatar
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    Re: PFO possible occluder failure

    I'd give your cardiologist a ring. I had my pfo closed in december by Mark Turner who is very very helpful. if you wish i can pm you his number.

    quick chat on the phone never hurts.

    ATB Greg

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