Diving exposes the body to pressure changes that can lead to the formation of gas bubbles in the venous circulation. In the presence of a patent foramen ovale (PFO), these bubbles may cross into the arterial circulation through right-to-left shunting. This mechanism is associated with an increased risk of decompression illness in divers.
Why a PFO may be relevant for divers
A PFO can allow venous gas bubbles to bypass the pulmonary filter and enter the arterial system. This is particularly relevant in:
– Divers with a history of decompression illness
– Divers with unexplained neurological symptoms after diving
– Divers with repeated or severe decompression events
Both professional and recreational divers may be affected.
Evaluation before diving decisions
The presence of a PFO alone does not automatically require closure.
A structured evaluation is essential and includes assessment of:
– Diving history and dive profiles
– Clinical events suggestive of decompression illness
– PFO anatomy and degree of right-to-left shunt
– Individual risk tolerance and future diving plans
Professional versus recreational diving
In professional or occupational diving, the presence of a clinically relevant PFO may restrict or preclude diving activities, depending on regulatory requirements, employer policies, and insurance frameworks.
In recreational diving, recommendations are usually more individualized and based on personal risk assessment.
PFO closure and diving
If a PFO is considered clinically relevant for diving-related risk, diving should be avoided until evaluation is completed and, if chosen, PFO closure has been performed and confirmed.
After successful PFO closure and appropriate follow-up, diving is typically possible again with individualized recommendations.
In professional diving, return-to-dive clearance after closure depends on the applicable regulatory and occupational framework.
Who we frequently see
We frequently evaluate:
– Divers who were advised to stop diving without individualized assessment
– Divers seeking a second opinion regarding PFO closure
– Recreational divers who wish to continue diving safely
– Divers with additional PFO-related considerations (e.g. migraine, prior embolic events)
Important considerations
PFO closure for divers is not a routine decision and should never be based on screening alone.
The choice of closure technique depends on anatomy, clinical context, and individual preferences, including considerations such as avoidance of permanent implants.
Our approach
Our goal is not simply to close a PFO, but to provide a balanced and individualized recommendation that aligns medical considerations with the diver’s personal and professional goals.