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Has anyone considered going and getting a private PFO test done (TTE)?

I don't mean you guys that have had a hit which has been deemed unexplained/undeserved. I mean people who have never had a hit and who just want that security of knowing one way or the other.

It's something I've considered at length and with the cost quoted at around £200 - £300[1] is not a huge price to pay for piece of mind.

The obvious downside is that once you know about it you have to do something about it and at £10000[1] for a closure procedure it can leave a serious dent in your diving budget!

I suppose you could not bother having it closed and simply pad out your tables/computer to try and allow for it but that's not something I would do.

Just a thought....any comments?


[1] Figures obtained from Migraine.Org
 

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Just not enough dive time.
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I've always wondered about that too. A couple of years ago I had a minor heart scare, I asked if they could tell if I had a PFO, the echo sounder would apparently give a fairly good indication. The heart scare proved to be nothing, my valves were working fine and the liklihood of me having a PFO were very slim, so in short if you get a chance to have an echo sound during a routine procedure I'd go for it. I wouldnt have gone out of my way to have a test though. I think the head in the sand approach works just fine. :)

Matt
 

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I was present at a talk by Dr Bryson DDRC a couple of weeks back.

Part revolved around the idea that divers appear to be taking PFO & closure as a panacea for explaining and preventing many DCI incidents. He made a point of stating that the procedures for test and closure have a risk to them.

He also mentioned that there is at least one person considering open heart surgery for the removal of the closure device. The device is interfering with the electrical elements of the functioning of the heart - the person cannot work as a result.

Adrian
 

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a lot of people in one of my clubs thought about it after we had 3 pfo's diagnosed within a year, but in the end they all decided not to as they didn't want to go through the decision as to what to do if they found they had a pfo...
 

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I was present at a talk by Dr Bryson DDRC a couple of weeks back.

Part revolved around the idea that divers appear to be taking PFO & closure as a panacea for explaining and preventing many DCI incidents. He made a point of stating that the procedures for test and closure have a risk to them.

He also mentioned that there is at least one person considering open heart surgery for the removal of the closure device. The device is interfering with the electrical elements of the functioning of the heart - the person cannot work as a result.

Adrian
I wanted to get to that - was that at the AGM?

There are risks involved to the fix as i know as well as anyone else as i've had most of them...and some new ones!

That doesn't mean i wouldn't have the fix if i had been bent, but if i hadn't had DCI i'd question having an operation on my heart when it had given me no previous problems....
 

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I was present at a talk by Dr Bryson DDRC a couple of weeks back.

Part revolved around the idea that divers appear to be taking PFO & closure as a panacea for explaining and preventing many DCI incidents. He made a point of stating that the procedures for test and closure have a risk to them.

He also mentioned that there is at least one person considering open heart surgery for the removal of the closure device. The device is interfering with the electrical elements of the functioning of the heart - the person cannot work as a result.

Adrian
My thoughts exactly, reinforced by conversations with hyperbaric doctors at Haslar and from a friend who is medically unable to dive anymore after the closure procedure damaged her heart.

Safe diving,
Steve
 
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Has anyone considered going and getting a private PFO test done (TTE)?
I considered it a while back mainly because I am a hypochondriac.
But no diving (till it's fixed) if you find one somewhat put me off especially I as I've never had a problem and always dive conservatively.

Now I know that it also costs £10k I'm even surer that I'll not bother.
 

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I've certainly never considered having at TOE (tube down throat heart scan) for a number of reasons.

Firstly it involves a tube down the throat which has its own complication rate (admittedly very small). When you hear what people say under sedation for endoscopy it is frankly disturbing.
The next issue is, if you discover you have a PFO what do you do about it? Some studies suggest that 25% of people have PFO, but less than 25% of divers get bent. It is not simply PFO = bend, no PFO or PFO closed won't get bent even if diving appropriately.
As sonme have mentioned closure carries its own risks. If I had a large PFO which was likely to cause me problems on the surface, then I would get it fixed no problem; but it is not as straightforward if it is a small one. The rates of complication are low but potentially catastrophic.
 

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I've certainly never considered having at TOE (tube down throat heart scan) for a number of reasons.

Firstly it involves a tube down the throat which has its own complication rate (admittedly very small). When you hear what people say under sedation for endoscopy it is frankly disturbing.
The next issue is, if you discover you have a PFO what do you do about it? Some studies suggest that 25% of people have PFO, but less than 25% of divers get bent. It is not simply PFO = bend, no PFO or PFO closed won't get bent even if diving appropriately.
As sonme have mentioned closure carries its own risks. If I had a large PFO which was likely to cause me problems on the surface, then I would get it fixed no problem; but it is not as straightforward if it is a small one. The rates of complication are low but potentially catastrophic.
There is no need for a TOE to test for a PFO. Ultrasound as it is today allows a PFO test with an ultrasound probe on the outside of your chest. This is a TTE test (transthoracic) and is found to be effective as TOE for diagnosis according to several studies and my cardiologist.

As for what to do if you have a PFO - well it comes down to if its causing you issues and what additional risk of stroke you have if you don't have it fixed. Studies have shown that a shunting PFO can give you up to 8 times higher level of risk of stroke during your life than not having one. 8 times a small risk though is still a small risk.

In my case I got DCS on a dive and wanted to find out if there was an underlying cause. Due to the diving I was doing (enough deco to cause big problems if it went wrong) I felt the risk of DCS was enough to make me get the PFO fixed or necessitate me dramatically cutting back my diving.

If you've never had DCS issue then screening may seem over the top. I thought about it after reading about PFO's but never got tested until after a bend. I think a bend that isn't explainable (i.e. no severe de-hydration, no rapid ascent, no missed stops etc) should prompt some thought on the matter. The test itself is as risky as a blood test (as they puncture a vein) so we aren't exactly talking about a high risk or uncomfortable procedure. What do you lose by knowing? If you've got one maybe you then dive more conservatively or maybe you get it fixed.

Cheers
Al
 

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"The test itself is as risky as a blood test (as they puncture a vein)"
Ho, ho -you've never had an attempt to gain femoral access or as it's more properly known central venous access because you are accessing a large vein. If you think it's no different, then I'd be happy to access your femoral vein with no local anaesthetic. The risks again from simply getting vascular access are low, but definite. If putting in a femoral line I consent my patients for damage to other structures (including femoral artery which can lead to a "false aneurysm"), haematoma, and infection (the groin is a dirty, dirty place!).
"there is no need for a TOE"
Says who? If your cardiologist is happy with a TTE for you, then I'm sure that that is the right decision IN YOUR CASE. It may not be the right decision for everyone. I'm not a cardiologist but I know that some people are just difficult to get good echo pictures of; there are a lot of variables - operator, patient etc.
Again, risk perception is interesting - as you say 8x a small risk is still a small risk, and there are many other variables to consider. My feeling is that for me, my pre-test probability of PFO is low, so to expose myself to a not particularly nice test for me is unacceptable.
Everyone's decision should be taken on an individual basis.
 

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A friend of mine,who years ago as a Trauma Surgeon had a PFO test before undertaking diving,went on to become a PADI Master diver(PADI?:teeth: ). Funny how it was his previously unknown Ear Pathology that went pear shaped,and finished his diving!
 

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"The test itself is as risky as a blood test (as they puncture a vein)"
Ho, ho -you've never had an attempt to gain femoral access or as it's more properly known central venous access because you are accessing a large vein. If you think it's no different, then I'd be happy to access your femoral vein with no local anaesthetic. The risks again from simply getting vascular access are low, but definite. If putting in a femoral line I consent my patients for damage to other structures (including femoral artery which can lead to a "false aneurysm"), haematoma, and infection (the groin is a dirty, dirty place!).
"there is no need for a TOE"
Says who? If your cardiologist is happy with a TTE for you, then I'm sure that that is the right decision IN YOUR CASE. It may not be the right decision for everyone. I'm not a cardiologist but I know that some people are just difficult to get good echo pictures of; there are a lot of variables - operator, patient etc.
Again, risk perception is interesting - as you say 8x a small risk is still a small risk, and there are many other variables to consider. My feeling is that for me, my pre-test probability of PFO is low, so to expose myself to a not particularly nice test for me is unacceptable.
Everyone's decision should be taken on an individual basis.
Hi Fee,

The vein they use is the one in your arm - same one they draw blood from. Don't know the technical term for it but I've had blood tests in the past and its the same one - hence my description that it's a risky as a blood test.

My cardiologist (a specialist in cogenital heart conditions at the Bristol Royal Infirmary) tests for a PFO with a TTE in all cases (his words) as he's not yet found the need for something more intrusive. When I was looking into it 6 months ago I found several published studies which stated the same view that TTE is appropriate.

As for the 8x a small risk I was referring to the second reason to have a PFO closed namely that a shunting PFO leaves you 8x as likely to have a stroke in your life. I wasn't referring to any risk of the test.

By all means make the decision on your own basis but I dissapprove of over-playing a minor test with what seems to me like a lack of information. I hope I've been able to explain what actually happens. The last thing anyone who has a DCS incident is someone telling them a PFO test is not an acceptable risk for them.

Thanks
Al
 

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Hi Al
having re-read posts I realise that we were talking at cross purposes - sorry! The femoral access is for a closure procedure rather than the echocardiogram. The cardiologists in every hospital that I have worked in have done TOEs to look for PFO in some patients. I'm not decrying your cardiologist in any way, but just trying to point out that every cardiologist may not share his view. Incidentally, most people are convinced that the specialist they see at hospital is the "top (wo)man". I just don't want people reading what you've written and saying "well the specialist in congenital heart disease at the BRI says that a TOE isn't needed".
I think that we agree that these cases should be managed on an individual basis, in discussion with an appropriate specialist.
 
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