Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic.
Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic; Department of Neurology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
JACC Cardiovasc Interv. 2014 Apr;7(4):403-8. doi: 10.1016/j.jcin.2013.12.199. Epub 2014 Mar 14.
This study sought to evaluate the effect of catheter-based patent foramen ovale (PFO) closure on the occurrence of arterial bubbles after simulated dives.
PFO 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.
A 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.
After 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).
No 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).
本研究旨在评估经导管卵圆孔未闭（PFO）封堵对模拟潜水后动脉气泡发生的影响。
由于气泡的反常栓塞，PFO 是潜水员减压病的一个危险因素。迄今为止，经导管 PFO 封堵减少动脉气泡的有效性尚未得到证实。
本病例对照观察性试验共纳入 47 名潜水员（年龄 35.4±8.6 岁，81%为男性），其中 PFO 患者（PFO 组）或接受经导管 PFO 封堵治疗（封堵组）。所有潜水员均在高压舱内模拟潜水后接受检查：34 名潜水员（PFO 组 19 名，封堵组 15 名）潜水至 18 米，潜水时间 80 分钟，13 名潜水员（PFO 组 8 名，封堵组 5 名）潜水至 50 米，潜水时间 20 分钟。在浮出水面后 60 分钟内，通过经胸超声心动图和经颅彩色编码超声分别评估静脉和动脉气泡的存在情况。
在 18 米潜水后，PFO 组中 74%的潜水员出现静脉气泡，封堵组中 80%的潜水员出现静脉气泡（p=1.0），动脉气泡分别为 32%和 0%（p=0.02）。在 50 米潜水后，PFO 组中 88%的潜水员出现静脉气泡，封堵组中 100%的潜水员出现静脉气泡（p=1.0），动脉气泡分别为 88%和 0%（p<0.01）。
PFO 组和封堵组之间静脉气泡的发生无差异，但经导管 PFO 封堵可完全消除模拟潜水后动脉气泡。（Nitrogen Bubble Detection After Simulated Dives in Divers With PFO and After PFO Closure；NCT01854281）。
