Patent Foramen Ovale and Fitness to Dive Consensus Workshop

Course overview

Learner Objectives As a result of having attended the meeting, the participants should have had the opportunity to: • Understand the process by which SPUMS and the UNSDMC produced a position statement on persistent foramen ovale and diving, and the rationale behind the position statement • Describe background issues requiring a position statement on persistent foramen ovale and diving • Describe the rationale behind the position statement on persistent foramen ovale and diving • Understand that physical exercise after diving led to an increased incidence of arterialization via IPAVAs compared to resting conditions. Arterialization during exercise was preventable with concurrent 100% O2 breathing and, arterialization while breathing atmospheric air ceased almost immediately after exercise was terminated. • Understand the available medical literature of patient foramen ovale closure and its relationship to diving. There will be emphasis on limitations in the published literatures and the clinical implications of such limitations. • Describe the Adverse events in clinical trials of PFO closure for stroke • Understand PFO and fitness to dive – evolving evidence Subject Matter • Question and answer session • PFO and fitness to dive – evolving evidence • Clinical experience with PFO – Review of 400 cases • Incidence of DCS in divers with RLS – a prospective study • The pathophysiology of microbubbles crossing a PFO or other right to left shunts • PFO, White Matter Hyperintensities & Altitude Exposures • Inducible intrapulmonary shunt pathways: Are they important in DCS? • VGE arterializaton in divers with closed foramen ovale • Right-to-Left shunt and probabilistic decompression modeling • Efficacy of trans-catheter closure of PFO for DCS • Adverse events in clinical trials of PFO closure for stroke • Risk-benefit analysis of PFO closure – a prospective study • Current state of knowledge – quality of evidence • Navy perspective • SPUMS consensus on PFO and diving • UHMS consensus on PFO and Diving Teaching Methods • Online video Live Lectures with use of power points • Question and Answer time • Handouts/Proceedings Evaluation Methods Evaluation is offered online at the end of the entire program,which evaluates the effectiveness of the meeting, that no bias was presented and overall objectives were met. References:Document that the subject matter is current and accurate by providing references or a bibliography with journal articles, text or reference books published within the last five years. Please submit according to APA (American Psychological Association) format. • Undersea and Hyperbaric Medicine Journal, Undersea and Hyperbaric Medical Society, North Palm Beach, Florida • UHMS Hyperbaric Oxygen Therapy Indications, Thirteenth Edition, Dr. Lindell Weaver, April 2014 (http://www.bestpub.com/books/hyperbaric-a-undersea-medicine/product/359-ebook-hyperbaric-oxygen-therapy-indications-thirteenth-edition.html) • PFO and the Diver, Costantino Balestra, Frans J. Cronje, Peter Germonpre, Alessandro Marroni • Physiology and Medicine of Diving, 5th Edition; Alf Brubakk, Tom Neuman, Peter Bennett, and David Elliott • Workshop Proceedings: https://www.diversalertnetwork.org/research/Conference/2015PFOFTDProceedings/2015-pfo-workshop-proceedings.pdf.