Domenico Cartoni, Maria Penco*, Stefano De Castro, Giuliana Valente***, Corrado Costanzo***, Antonio Pelliccia****, Laura Vitali Serdoz, Rachele Adorisio**, Francesco Fedele**.
Department of Clinical Medicine, *Cardiology of University of L’Aquila, **Department of Cardiovascular and Respiratory Sciences, La Sapienza University, ***Centro Iperbarico Romano, ****Istituto di Scienza dello Sport, CONI, Rome, Italy
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Patent foramen ovale has been recognise as a
pathophysiological mechanism of decompression illness in scuba divers. While patent foramen ovale
has found in up to 30% of healthy population, decompression illness develops in a relative low
number of divers.
To identify the echocardiographic findings of patent foramen ovale in divers at higher risk for
decompression illness, 66 trained divers (60 M and 6 F; mean age 35±8) were evaluated.
Transesophageal echocardiography detected a patent foramen ovale in 28/41 (68%) divers
with previous decompression illness and in 7/25 (28%) divers without the disease (p=0.003).
Patency at rest was detected in 17/28 (61%) PFO divers with disease vs 0/7 (0%) PFO divers
without disease (p=0.01). Moreover, patent foramen ovale divers with decompression illness
presented a wider patency diameter (1.9±1 vs 1.1±0.4 mm, p=0.04) if compared to those without
the disease. Contrast transthoracic echocardiography identified 28/35 PFO divers, with a sensitivity
of 80% and a specificity of 100%. Scuba divers with decompression illness present a high patent
foramen ovale prevalence when compared to divers without the disease. Right-to-left shunting at
rest and a wider patency diameter seem to identify those patent foramen ovale divers at higher
risk for decompression illness. Saline contrast transthoracic echocardiography appears a feasible
and useful screening tool for professional scuba diving fitness.
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