Forame ovale pervio: chiusura percutanea e ritorno alle immersioni

ossigenoterapia-iiperbarica

Interessante studio che valuta l’effetto protettivo della chiusura percutanea del forame ovale pervio (PFO) in subacquei con storia clinica pregressa di incidenti da decompressione (IDD).

Dei 59 subacquei trattati 4 hanno avuto ricorrenza di IDD nei 10 anni successivi, di questi 3 avevano residuo shunt quando invece erano stati previamente considerati con PFO chiuso. Molti dei subacquei hanno modificato, alla ripresa delle attività subacquee, le loro abitudini e i loro profili di immersione per cui è difficile dire quanto sia stato protettivo” per sé” l’intervento di chiusura.

Gli autori concludono che questo intervento non protegge completamente da recidiva di IDD sottolineando che lo sviluppo di IDD può essere associata ad un insieme di concause che vanno tenute presente e, se possibile, corrette. In ultimo suggeriscono che i subacquei, caso per caso, vadano informati sui possibili rischi e i benefici di questa procedura.

https://www.ncbi.nlm.nih.gov/pubmed/31683360

Undersea Hyperb Med. 2019 Sep - Dec - Fourth Quarter;46(5):625-632.

Percutaneous closure of patent foramen ovale for the secondary prevention of decompression illness in sports divers: mind the gap.

Vanden Eede M1, Van Berendoncks A1, De Wolfe D2, De Maeyer C3, Vanden Eede H4, Germonpré P5.

OBJECTIVE:
To evaluate the efficiency of percutaneous patent foramen ovale (PFO) closure on the recurrence of decompression illness (DCI).

DESIGN:
Retrospective, observational study with interview and questionnaire.

POPULATION:
59 scuba divers with a history of DCI who received a percutaneous PFO closure.

MAIN OUTCOME MEASUREMENTS:
Questionnaire about health status, dive habits and recurrence of DCI after PFO closure.

RESULTS:
A total of 59 divers with DCI were included. The most common manifestations of DCI were cutaneous or vestibular DCI. Procedural complications occurred in four patients but none with long-term consequences. Four patients had recurrence of DCI after closure during a 10-year follow-up. In three of these cases there was residual shunting, all of which were initially considered closed. The fourth patient had aggravating factors for his recurrent DCI. A quarter of the patients stated to have changed their diving habits. Four patients quit diving.

CONCLUSION:
Percutaneous PFO closure for secondary prevention of DCI is associated with few, but not negligible, complications. As a large portion of our cohort changed their diving habit after closure it is difficult to ascertain the efficiency of PFO closure for secondary prevention of DCI. However, the study shows that PFO closure does not fully protect against DCI, emphasizing that the relationship between PFO and DCI is but an association. As such it is imperative that divers be counseled to ensure they understand the risks as well as the benefits of percutaneous PFO closure in their specific case.

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