Effect of Catheter-Based Patent Foramen Ovale Closure on the Occurrence of Arterial Bubbles in Scuba Divers

ObjectivesThis study sought to evaluate the effect of catheter-based patent foramen ovale (PFO) closure on the occurrence of arterial bubbles after simulated dives.BackgroundPFO is a risk factor of decompression sickness in divers due to paradoxical embolization of bubbles. To date, the effectiveness of catheter-based PFO closure in the reduction of arterial bubbles has not been demonstrated.MethodsA total of 47 divers (age 35.4 ± 8.6 years, 81% men) with a PFO (PFO group) or treated with a catheter-based PFO closure (closure group) were enrolled in this case-controlled observational trial. All divers were examined after a simulated dive in a hyperbaric chamber: 34 divers (19 in the PFO group, 15 in the closure group) performed a dive to 18 m for 80 min, and 13 divers (8 in the PFO group, 5 in the closure group) performed a dive to 50 m for 20 min. Within 60 min after surfacing, the presence of venous and arterial bubbles was assessed by transthoracic echocardiography and transcranial color-coded sonography, respectively.ResultsAfter the 18-m dive, venous bubbles were detected in 74% of divers in the PFO group versus 80% in the closure group (p = 1.0), and arterial bubbles were detected in 32% versus 0%, respectively (p = 0.02). After the 50-m dive, venous bubbles were detected in 88% versus 100%, respectively (p = 1.0), and arterial bubbles were detected in 88% versus 0%, respectively (p < 0.01).ConclusionsNo difference was observed in the occurrence of venous bubbles between the PFO and closure groups, but the catheter-based PFO closure led to complete elimination of arterial bubbles after simulated dives. (Nitrogen Bubble Detection After Simulated Dives in Divers With PFO and After PFO Closure; NCT01854281

Ventricular fibrillation associated with aortic stenosis and coronary cascade

AbstractWe report a case of a patient with severe aortic stenosis in the setting of bicuspid valve and coronary cascade, who was successfully resuscitated from ventricular fibrillation occurring during physical exertion. Both conditions may cause steal effect leading to myocardial ischemia and ensuing ventricular tachyarrhythmia. Following replacement of the aortic valve by mechanical valve prosthesis, the patients declined implantation of cardioverter-defibrillator rendering doubts about possible independent association between ventricular fibrillation and coronary cascade