Úloha foramen ovale patens v patofyziologii vzniku dekompresní choroby.

Honěk, Jakub

Patent foramen ovale (PFO) has been associated with an increased risk of decompression sickness (DCS) in divers. Pathophysiologicaly this has been ascribed to paradoxical embolization of nitrogen bubbles from venous blood to systemic circulation, resulting in obstruction of peripheral capillaries and ischemic injury. However, the role of PFO has been largely debated and experimental and prospective clinical data has been missing. It is of note, that this hypothesis is not only of theoretical importance. The proof of PFO as a causative factor of DCS and, importantly, of unpredictable events (unprovoked DCS) could affect millions of divers worldwide through improved therapy and prevention. In our research we aimed to describe the pathophysiological role of PFO in decompression sickness and to determine whether the prevention of arterialization of post-dive venous gas emboli (VGE) would decrease the incidence of unprovoked DCS in divers. We have screened 489 scuba divers for the presence of PFO by means of transcranial color-coded Doppler ultrasonography. In a retrospective analysis we found that the incidence of unprovoked decompression sickness was 7% among these divers and that PFO was the only risk factor. Subsequently, we have studied the occurrence of VGE and arterial gas emboli (AGE) in divers with...

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