Patent Foramen Ovale: hole in the heart or hole in the market?

Divers Seminar

Seminar program Diver 2014

Decompression sickness occurs after diving and is caused by the formation of nitrogen bubbles in tissue and/or blood vessels when compressed air is used. An important cause is exceeding the “no-deco” limits. So much nitrogen is then absorbed into the tissue that it can no longer be safely dissolved in the venous (venous) blood and discharged via the lungs within the usual time limits. The lungs normally act as a filter that traps nitrogen bubbles.

If there are a lot of nitrogen bubbles, this exceeds the filtering capacity of the lungs and nitrogen bubbles still end up in the arteries. The nitrogen bubbles in the arteries can then get stuck in the small blood vessels of the brain, for example, and cause damage there, such as a stroke with paralysis or severe dizziness.

However, divers who adhere to the “no-deco” limits can also develop decompression sickness. In that case, I will look for shunts, ie connections between the venous and arterial (venous and arterial) circulation. These shunts bypass the lungs, reducing the function of the lungs as a filter for the nitrogen bubbles. One of the possible shunts is the Patent Foramen Ovale, or PFO. This is a connection between the left and right atrium of the heart. Normally it is functionally closed, but under special circumstances it can still open and nitrogen bubbles can end up in the arteries.

A PFO can be closed with an “umbrella”. There is discussion about which PFOs qualify for this and in which syndromes a PFO should be closed. There is also discussion about the preventive closure of PFOs in people who have not yet experienced decompression sickness, for example in trimix divers. Since a PFO occurs in approximately 1/3 of the (diving) population, the preventive closure of a PFO in divers could be a gap in the market. What do the experts say?

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Rienk Rienks is a cardiologist at the UMCU and the Central Military = Hospital (CMH) in Utrecht. He also has an outpatient clinic for (among others) divers with cardiological problems, CardioExpert, in Rotterdam.
Through his work at the CMH he came into contact with cardiac problems of diving soldiers, and has since acquired an expertise in this area. He has good contacts with the Diving Medical Center (DMC) of the Royal Netherlands Navy in Den Helder. In 2011 he obtained the certificate “Diving doctor A”. He has been diving since 1982 and is qualified as a PADI advanced open water diver, rescue diver, and Nitrox diver.
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