title: An audit of persistent foramen ovale closure in 105 divers.
abstract: BACKGROUND
  Right-to-left shunt across a persistent foramen ovale (PFO) has been associated with cutaneous, neurological and vestibular decompression illness (DCI). Percutaneous closure of a PFO has been used to reduce the risk of DCI. There are no randomised controlled trial data to support PFO closure for the prevention of decompression illness (DCI), so the need for audit data on the safety and efﬁcacy of this technique has been recognised by the National Institute of Health and Clinical Excellence in the UK.
  
  
  METHODS
  Retrospective audit of all transcatheter PFO closures to reduce the risk of DCI performed by a single cardiologist with an interest in diving medicine.
  
  
  RESULTS
  A total of 105 eligible divers undergoing 107 procedures was identiﬁed. There was a low rate of procedural complications; a rate lower than a recent randomised trial of PFO closure for stroke. Atrial ﬁbrillation required treatment in two patients. One patient with a previously repaired mitral valve had a stroke that was thought to be unrelated to the PFO closure. Sixteen divers had minor post-procedure symptoms not requiring any treatment. Two divers required a second procedure because of residual shunt; both subsequently returned to unrestricted diving. Eighty-one of 95 divers in whom follow-up bubble contrast echocardiography was available returned to unrestricted diving.
  
  
  CONCLUSIONS
  The PFO closure procedure appeared to be safe and was associated with the majority of divers being able to successfully return to unrestricted diving.
authors.affiliation: Medical School, University of Bristol, Bristol, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Pearman
authors.affiliation: Bristol Heart Institute, Bristol Royal Inﬁ rmary, Bristol, UK.
authors.forename: Luc
authors.initials: L
authors.lastname: Bugeja
authors.affiliation: Bristol Heart Institute, Bristol Royal Inﬁ rmary, Bristol, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Nelson
authors.affiliation: Bristol Heart Institute, Bristol Royal Inﬁ rmary, Bristol, UK.
authors.forename: Gergely V
authors.initials: GV
authors.lastname: Szantho
authors.affiliation: Level 7 Bristol Heart Institute, Bristol Royal Inﬁrmary, Marlborough Street , Bristol BS2 8HW, UK, E-mail: markturner3@nhs.net.
authors.forename: Mark
authors.initials: M
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D000328:Adult; D019985:Benchmarking; D004242:Diving; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology; D061646:Operative Time; D009929:Organ Size; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000009:adverse effects; D014463:Ultrasonography
keywords: Patent foramen ovale (PFO); clinical audit; echocardiography; persistent foramen ovale; right-to-left shunt; transcatheter closure