Relation between Directly Detected Patent Foramen Ovale and Ischemic Brain Lesions in Sport Divers

  1. Markus Schwerzmann, MD;
  2. Christian Seiler, MD;
  3. Ernst Lipp, MD;
  4. Raphael Guzman, MD;
  5. Karl O. Lövblad, MD;
  6. Martin Kraus, MD; and
  7. Nils Kucher, MD
  1. From Swiss Cardiovascular Center Bern and University Hospital, Bern, Switzerland.

    Abstract

    Background: In divers, the significance of a patent foramen ovale and its potential relation to paradoxical gas emboli remain uncertain.

    Objective: To assess the prevalence of symptoms of decompression illness and ischemic brain lesions in divers with regard to the presence of a patent foramen ovale.

    Design: Retrospective cohort study.

    Setting: University hospital and three diving clubs in Switzerland.

    Participants: 52 sport divers and 52 nondiving controls.

    Measurements: Prevalence of self-reported decompression events, patent foramen ovale on contrast transesophageal echo-cardiography, and ischemic brain lesions on magnetic resonance imaging.

    Results: The risk for decompression illness events was 4.5-fold greater in divers with patent foramen ovale than in divers without patent foramen ovale (risk ratio, 4.5 [95% CI, 1.2 to 18.0]; P = 0.03). Among divers, 1.23 ± 2.0 and 0.64 ± 1.22 ischemic brain lesions per person (mean ± SD) were detected in those with and those without patent foramen ovale, respectively. Among controls, 0.22 ± 0.44 and 0.12 ± 0.63 lesion per person were detected (P < 0.001 for all groups).

    Conclusions: Regardless of whether a diver has a patent foramen ovale, diving is associated with ischemic brain lesions.

    Article and Author Information

    • Acknowledgments: The authors thank Aija Kinnunen, Marika Kabok, and Liza Needergard for assistance with transesophageal echocardiography.

    • Requests for Single Reprints: Christian Seiler, MD, Swiss Cardiovascular Center Bern, Department of Cardiology, University Hospital, 3010 Bern, Switzerland; e-mail, christian.seiler.cardio{at}insel.ch.

    • Current Author Addresses: Drs. Schwerzmann, Seiler, Lipp, and Kucher: Swiss Cardiovascular Center Bern, Cardiology, University Hospital, 3010 Bern, Switzerland.

    • Drs. Guzman and Lövblad: Department of Neuroradiology, University Hospital Bern, 3010 Bern, Switzerland.

    • Dr. Kraus: Schweizerische Gesellschaft für Unterwasser-und Hyperbarmedizin, Rathausstrasse 11, 8570 Weinfelden, Switzerland.

    • Author Contributions: Conception and design: M. Schwerzmann, C. Seiler.

    • Analysis and interpretation of the data: M. Schwerzmann, C. Seiler, K. Lövblad.

    • Drafting of the article: M. Schwerzmann, C. Seiler.

    • Critical revision of the article for important intellectual content: M. Kraus.

    • Final approval of the article: C. Seiler.

    • Provision of study materials or patients: M. Schwerzmann, C. Seiler, E. Lipp, R. Guzman, N. Kucher.

    • Statistical expertise: M. Schwerzmann, C. Seiler.

    • Administrative, technical, or logistic support: M. Schwerzmann, C. Seiler, E. Lipp, R. Guzman, K. Lövblad, M. Kraus, N. Kucher.

    • Collection and assembly of data: M. Schwerzmann, C. Seiler, E. Lipp, K. Lövblad.

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    1. Ann Intern Med January 2, 2001 vol. 134 no. 1 21-24
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