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Posted : June 20, 2007
Hi Dr Firth

A few weeks ago I had an unsuccessful op to repair a PFO following 'undeserved' decompression sickness. I had a further bubble study done, and while they are confident I don't have a PFO, there was still bubble migration between the right and left chambers, at an intereval of 7-9 cardiac cycles. The doctor suggested it might be pulmonary, and said I should have an angiogram and/or a CAT scan, but I am no closer to knowing what the solution is than before.
What does 'it could be pulmonary' actually mean? Does this have implications for my general long term health? Is it something that can be fixed, and if so, when can I go diving again? It may sound trivial but I've been out of the water for 10 months now and am getting desperate!

Sincerely
Arianna


Answer
Posted : June 21, 2007
Hello. This is complicated I'm afraid - certainly not trivial! It may help to do some explaining (sorry if this gets a little technical...) The concept you need to understand is right to left shunting, where blood bypasses the lungs and goes straight from the right side of the heart to the left. A PFO is one form of right to left shunt, but there are others, including ASD (atrial septal defect) and pulmonary arteriovenous malformations (AVM). The latter is what the doctor is suggesting, as it is most likely in the absence of an obvious PFO on echo. A pulmonary AVM is basically an abnormal communication between the pulmonary artery and pulmonary vein, which again allows blood (and bubbles) to bypass the lungs. They can be diagnosed by CT scan or pulmonary angiography. Most are congenital (ie present since birth). They can be treated, either surgically or with embolisation, but this depends very much on the exact type and individual circumstances of each case. Whether diving is possible afterwards again is difficult to say - the cardiologist would have to be sure that there is no residual right to left shunting. Hope that helps - if you need to discuss further then phone on 02078064028 for an appointment.
Regards, Dr O
Answer provided by Dr Oliver Firth
Dr Ollie Firth
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