title: Joint position statement on persistent foramen ovale (PFO) and diving. South Paciﬁc Underwater Medicine Society (SPUMS) and the United Kingdom Sports Diving Medical Committee (UKSDMC).
abstract: This consensus statement is the result of a workshop at the SPUMS Annual Scientiﬁc Meeting 2014 with representatives of the UK Sports Diving Medical Committee (UKSDMC) present, and subsequent discussions including the entire UKSDMC. Right-to-left shunt across a persistent or patent foramen ovale (PFO) is a risk factor for some types of decompression illness. It was agreed that routine screening for PFO is not currently justiﬁable, but certain high risk sub-groups can be identiﬁed. Divers with a history of cerebral, spinal, inner-ear or cutaneous decompression illness, migraine with aura, a family history of PFO or atrial septal defect and those with other forms of congenital heart disease are considered to be at higher risk. For these individuals, screening should be considered. If screening is undertaken it should be by bubble contrast transthoracic echocardiography with provocative manoeuvres, including Valsalva release and snifﬁng. Appropriate quality control is important. If a shunt is present, advice should be provided by an experienced diving physician taking into account the clinical context and the size of shunt. Reduction in gas load by limiting depth, repetitive dives and avoiding lifting and straining may all be appropriate. Divers may consider transcatheter device closure of the PFO in order to return to normal diving. If transcatheter PFO closure is undertaken, repeat bubble contrast echocardiography must be performed to conﬁrm adequate reduction or abolition of the right-to-left shunt, and the diver should have stopped taking potent anti-platelet therapy (aspirin is acceptable).
authors.affiliation: School of Medicine, University of Tasmania and Department of Diving and Hyperbaric Medicine Royal Hobart Hospital Hobart, Tasmania 7000 Australia, Phone: +61-(03)-6222-8193, E-mail: david.smart@dhhs.tas.gov.au.
authors.forename: David
authors.initials: D
authors.lastname: Smart
authors.affiliation: Department of Anaesthesiology, University of Auckland and Auckland City Hospital, Auckland, New Zealand.
authors.forename: Simon
authors.initials: S
authors.lastname: Mitchell
authors.affiliation: Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Wilmshurst
authors.affiliation: Bristol Heart Institute, Bristol, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Turner
authors.affiliation: Department of Hyperbaric Medicine, Fiona Stanley Hospital, Perth, Western Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Banham
mesh_terms: D003665:Decompression Sickness / Q000209:etiology; D004242:Diving; D004452:Echocardiography / Q000379:methods*; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D055989:Septal Occluder Device; D012955:Societies, Medical; D013178:Sports Medicine
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Patent foramen ovale (PFO); cardiovascular; decompression illness; health surveillance; medical society; persistent foramen ovale; transcatheter closure; ﬁtness to dive