DIR Diving Blog

Interesting study that might explain how someone can dive for years and then later discover a PFO:

http://linkinghub.elsevier.com/retrieve/pii/S0002914905000500

Well I’m back at home now after my PFO closure. I thought there might be a bit of interest in the op so I figured I’d post up some detail.

Essentially a flap of tissue in the heart has failed to seal up and this allows bubbles which would normally be filtered by the lungs to bypass the filter mechanism and carry on to the body.

A bit of background on PFO’s can be found below:
gue.com/Research/Exercise/q3_1j.htm

I had my op done privately in the UK which meant I bypassed the normal NHS waiting lists and only had to wait a few weeks between the test and the closure. I checked into hospital and spent several hours meeting various medical staff – anaesthetist, cardiologist, cardiac nurse, pharmacist etc. By the time I got to the operating theatre and met the full team of 10 people who would be working on me I was very nervous and questioning my sanity in agreeing! There was a person for every task – a radiologist, an ultrasound specialist, anaestheist, cardiologist, cardiac nurses, etc.

The procedure was done under a general anaesthetic as they needed to put an ultrasound probe down my throat to help them see what was going on. In order to make sure this didn’t cause issues they wanted to put a tube down my throat to help me breathe as well. They put a needle into the back of my hand and I drifted off at that point.

To install the device they access the venous system through the femoral vein and thread a catheter all the way up to the heart. They then have to use the catheter probe to measure the size of the opening. 5mm in my case. They thread the catheter through the hole to the other side of the heart to create a guideline. This is used to guide the device itself through the opening where one side is opened and the device is positioned. Once in right place the other side is opened like so:

This creates a seal but on top of that tissue grows over the device and within a few months it becomes part of the heart.

After the op I came round in the recovery room and felt ok albeit groggy. My leg bled for about 30 minutes which was in part due to the anti-coagulants they’d given me during the op. Once they were comfortable the bleeding had stopped and that my ECG and blood pressure was good I was moved back to the ward. Over the next 4 hours I was closely monitored to make sure all was well. The cardiologist visited and carried out an ultrasound and I could actually see my heart beating with the device visible on screen.

Within a couple of hours I was sat up and eating and 4 hours post op I was allowed to get up. I was then checked the day after the op again by ultrasound to confirm the device was well placed and that there was still no visible issues to the heart i.e. blood or fluid build up.

For the week post the op I can’t drive and I’m off work. Main risk is actually the vein in my leg rather than my heart. After 4 weeks I’m considered OK and allowed back to the gym and most activities. Proper deco diving is at least 3 months and bubble test away. Possible side-effects. Well it is a low risk op but not a no-risk op. Surgery risks include damage to throat from the probe, damage to the vein or artery in the leg, damage to the heart. Post op the risks are the device coming free, slightly higher risk of stroke (mitigated by anti-coagulants) for the first few weeks, migraines and heart arrythmia. However these are all low risk events.

I’m currently feeling a little sore but I’m hopeful that the decision to have this done will be borne out. Success rate of the ops is somewhere near 95-98% dependent on studies so I’m reasonably hopeful I’ll get a pass back to diving early next year.

Arranged a last minute dip with Fraser at Wraysbury. We did a couple of 3 bottle dives which was actually good fun to do. The water temperature was down to 8 degrees but my drysuit was now dry and I’d added the fourth element artic it wasn’t too bad.

Back to working with 3 bottles with Clare and Fraser. We had a good day even if I did feel a bit rusty.