title: Patent foramen ovale closure in recreational divers: effect on decompression illness and ischaemic brain lesions during long-term follow-up.
abstract: OBJECTIVE
  To test the effect of patent foramen ovale (PFO) closure on neurological events in divers.
  
  
  METHODS
  Prospective, non-randomised, longitudinal three-arm study.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  104 scuba divers with a history of major decompression illness (DCI).
  
  
  METHODS
  Transcutaneous PFO closure.
  
  
  METHODS
  Baseline and three follow-up examinations with a questionnaire about health status and diving habits/accidents, transoesophageal echocardiography at baseline for PFO grading, cerebral MRI at all examinations.
  
  
  RESULTS
  39 divers had no PFO, 26 had a PFO and chose to undergo percutaneous closure and 39 had a PFO, but decided not to undergo closure. The total number of dives, including those performed before baseline and those during long-term follow-up, was 81,654; 18,394 dives during the follow-up period of 5.3 ± 0.3 years, during which there were a total of five major neurological DCI events-namely 0 in the no PFO group, 0.5 ± 2.5/10⁴ dives in the PFO closure group and 35.8 ± 102.5/10⁴ dives in the PFO no closure group (four events; p = 0.045 between the PFO groups). In the groups, no PFO, PFO closure and PFO no closure, there were 1.1 ± 2.6, 0.8 ± 1.4, 3.3 ± 6.9 ischaemic brain lesions, respectively, at follow-up (p = 0.039 between the PFO groups)-that is, 16 ± 42/10⁴ dives in the no PFO group, 6 ± 13/10⁴ dives in the PFO closure group and 104 ± 246/10⁴ dives in the PFO no closure group (overall p = 0.042; p = 0.024 between the PFO groups).
  
  
  CONCLUSIONS
  PFO closure in continuing divers appears to prevent symptomatic (major DCI) and asymptomatic (ischaemic brain lesions) neurological events during long-term follow-up.
authors.affiliation: Department of Cardiology, University Hospital, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Billinger
authors.forename: Rainer
authors.initials: R
authors.lastname: Zbinden
authors.forename: Raffaela
authors.initials: R
authors.lastname: Mordasini
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Markus
authors.initials: M
authors.lastname: Schwerzmann
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Christian
authors.initials: C
authors.lastname: Seiler
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000175:diagnosis / Q000517:prevention & control*; D006328:Cardiac Catheterization; D003665:Decompression Sickness / Q000517:prevention & control*; D004242:Diving / Q000009:adverse effects* / Q000706:statistics & numerical data; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000601:surgery*; D006304:Health Status; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011998:Recreation