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Original article
Patent foramen ovale closure in recreational divers: effect on decompression illness and ischaemic brain lesions during long-term follow-up
  1. Michael Billinger,
  2. Rainer Zbinden,
  3. Raffaela Mordasini,
  4. Stephan Windecker,
  5. Markus Schwerzmann,
  6. Bernhard Meier,
  7. Christian Seiler
  1. Department of Cardiology, University Hospital, Bern, Switzerland
  1. Correspondence to Professor Christian Seiler, University Hospital, CH-3010 Bern, Switzerland; christian.seiler{at}


Objective To test the effect of patent foramen ovale (PFO) closure on neurological events in divers.

Design Prospective, non-randomised, longitudinal three-arm study.

Setting Tertiary referral centre.

Population 104 scuba divers with a history of major decompression illness (DCI).

Intervention Transcutaneous PFO closure.

Main outcome measures 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).

Conclusion PFO closure in continuing divers appears to prevent symptomatic (major DCI) and asymptomatic (ischaemic brain lesions) neurological events during long-term follow-up.

  • Patent foramen ovale
  • diving
  • decompression illness
  • neurological events
  • coronary stenting
  • coronary intervention
  • percutaneous valve therapy
  • congenital heart disease
  • pulmonary hypertension
  • echocardiography
  • EBM
  • cardiac catheterisation
  • interventional cardiology
  • coronary collateral circulation
  • coronary physiology
  • coronary flow
  • intracoronary Doppler
  • Doppler echocardiography

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  • MB and RZ contributed equally to this work.

  • Competing interests None.

  • Ethics approval From the ethics committee of the Kanton of Berne, Switzerland.

  • Provenance and peer review Not commissioned; externally peer reviewed.