Patent Foramen Ovale and Dive Fitness 

PFO and Lessons I Hope I’ve Learned I thought I would share this. When a good friend of mine was bent as a result of a PFO, I actually delayed his treatment by some hours because it seemed inconceivable to me that his profile could have caused DCI. I think there are some lessons worth sharing here. At some point, I’ll write up a full report. The diver was 19 years of age, and physically fit. It was his first dive in several days and the profile was 45 minutes with a maximum depth of 9 metres. I was the senior diver. The diver was relatively inexperienced and had a basic diving qualification, not a leadership rating. After we finished the dive, we went our separate ways. The diver messaged me to discuss the following days dive plan and mentioned a pain in one bicep. We went back and forth over messenger over the next several hours, before I called DDRC, around midnight UK time for advice. The event took place overseas. When I called DDRC, who were extremely helpful, they thought it unlikely to be DCI. However, I knew when I made the call, they would recommend the diver be examined because DCI could not be excluded. The diver was taken to the local A and E. Protocol is he should have been treated as a priority case because he had been diving. Most of the admitting discussion was in a language I don’t speak. So, I did not realise he’d basically been asked to wait to be seen. Fortunately, a friend of mine at the hospital intervened and the diver was seen. I spoke to the attending Doctor who then followed up with DDRC and the diver was treated at a hyperbaric medical centre within a large, well-equipped hospital. The diver was later referred to a specialist cardiologist, who diagnosed a PFO. This was closed and the diver has been certified fit to dive, including passing a commercial diving medical at DDRC. Mistakes I Made Firstly, I am well aware of incidence of PFO. A number of people I know have been bent as a result of PFO’s. They have often made a considerable number of dives before they got DCI, and most of them were not making dives to great depth or one’s that involved decompression. So, PFO caused DCI was on my radar. Second, I hold instructor ratings from three agencies - PADI, BSAC and NAUI. Of the three agencies, NAUI tested me most thoroughly on my theoretical knowledge. I consider myself fairly well -read and was familiar with many of the DCI studies published by DDRC, DAN, UHMS and AAUS. I was also aware of the Hahn tables that sought to mitigate the underserved hits that occurred well within the tables and, I assume, were mostly caused by PFO’s. I can’t claim wilful ignorance of PFO. Third - despite all of this ‘knowledge’, I really did not think the diver could be bent. I had planned some CESA training, which we did not do, so there were no fast and repeated ascents involved. Had there been, my whole thinking would have shifted to this probably is DCI and I would have acted much, much earlier. Fourth - as per my training, I insisted the diver was taken to A and E and handed off to professional care givers. At that point, I let my guard down. The language barrier did not help, because I might have realised then that the incident was not being taken as seriously as it should. Fifth, and this is a point I want to make very strongly. We do not talk enough about PFO in training. This, I think, needs to be something discussed from entry- level when we talk about causes, signs and symptoms of DCI. We need to underscore that underserved hits occur and can do so well within the dive schedules that would seem very safe. None of my own training has emphasised that point. We need to counter that so people don’t make the mistakes I did. In fact, had the diver himself not badgered me about his suspicion’s he had DCI, I don’t think I’d have acted. Best Steve.

I had mild symptoms after 12 hours of a no decompression dive but I had a rapid ascent. I had 13 hours in a hyperbaric chamber. 3 weeks later the left side of my face was tingling, and I ended up 2 days at the hospital. They found I have a PFO, and I had a successful PFO-closure two days ago. I think, this should be emphasized at every diving level.

I had a Strong DD :(