Open AccessEchocardiography – techniques and pitfalls whilst diagnosing persistent (patent) foramen ovale as a risk factor in divers with a history of decompression sickness
Author(s) -
Charles Paul Azzopardi,
Kurt Magri,
Alexander Borg,
Jake Schembri,
Jonathan Sammut
Publication year - 2021
Publication title -
diving and hyperbaric medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.389
H-Index - 20
eISSN - 2209-1491
pISSN - 1833-3516
DOI - 10.28920/dhm51.1.98-102
Subject(s) - patent foramen ovale , medicine , decompression sickness , shunting , shunt (medical) , decompression , cardiology , surgery , migraine
The case of a diver with a history of decompression sickness (DCS) after recreational scuba diving is presented. Cutis marmorata, a subtype of cutaneous DCS, has been consistently associated with the presence of a persistent (patent) foramen ovale (PFO) as a risk factor. Diagnostic uncertainty arose when transthoracic echocardiography with antecubital injection of agitated saline bubbles (ASBs) did not show any significant shunt, but the presence of a large Eustachian valve was counteracted by intra-femoral injection of ASBs, showing a large PFO with spontaneous shunting. The importance of proper echocardiography techniques prior to resorting to intra-femoral injection of ASBs to counteract the haemodynamic effects of the Eustachian valve is emphasised.