A small hole in the atrial septum can cause any severe neurological disorders, patent foramen ovale (PFO) – a cause or trigger that today can be given safe treatment without drug therapy for a long duration. Before birth there is a connection between the two atria, which closes immediately after birth, but for approximately 20% of humanity this is lacking. If blood pressure goes up on the right hand side of the heart, the hole can be reopened and the blood clot along with small bubbles (for divers) can move to the left heart, reach the brain and cause anything from passenger circulation disorders to permanent stroke.
It has long been known that divers with PFO are exposed to an increased risk of paradoxical gas embolism which may accompany serious decompression mishaps. This risk is probably small for amateur divers. However, professional divers who by their professional scope, (depth of dive), show certain dive profiles which most likely cause the passage of nitrogen to veins and in that case may cause embolism. Since neurological complaints of patients who have suffered a paradoxical embolism because of PFO are similar to those of patients with severe migraine that appears giving nonspecific signals, (called an aura), these patients should be especially observed in that regard. Until a few years, PFO could only be closed with an open heart surgery. Today you can prevent operation for practically all patients and close the PFO with a cardiac catheterization technique.
The procedure is very low risk but this type of intervention should only be performed in centers with experience in treatment of congenital heart disease. There have been about 200,000 PFO closure interventions worldwide. With the double umbrella system that we have at present, rates reach more than 95% of immediate closure with a very low risk. Most survey data shows that after 10 years almost none of the patients (96%) suffer from anymore neurological or arterial stroke.
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