PFO Closure

**Alastair** · December 13th, 2006, 12:17 AM

Well I'm back at home now after my PFO closure. I thought there might be a bit of interest in the op so I figured I'd post up some detail.

Essentially a flap of tissue in the heart has failed to seal up and this allows bubbles which would normally be filtered by the lungs to bypass the filter mechanism and carry on to the body.

A bit of background on PFO's can be found below:
gue.com/Research/Exercise/q3_1j.htm

I had my op done privately in the UK which meant I bypassed the normal NHS waiting lists and only had to wait a few weeks between the test and the closure. I checked into hospital and spent several hours meeting various medical staff - anaesthetist, cardiologist, cardiac nurse, pharmacist etc. By the time I got to the operating theatre and met the full team of 10 people who would be working on me I was very nervous and questioning my sanity in agreeing! There was a person for every task - a radiologist, an ultrasound specialist, anaestheist, cardiologist, cardiac nurses, etc.

The procedure was done under a general anaesthetic as they needed to put an ultrasound probe down my throat to help them see what was going on. In order to make sure this didn't cause issues they wanted to put a tube down my throat to help me breathe as well. They put a needle into the back of my hand and I drifted off at that point.

To install the device they access the venous system through the femoral vein and thread a catheter all the way up to the heart. They then have to use the catheter probe to measure the size of the opening. 5mm in my case. They thread the catheter through the hole to the other side of the heart to create a guideline. This is used to guide the device itself through the opening where one side is opened and the device is positioned. Once in right place the other side is opened like so:

This creates a seal but on top of that tissue grows over the device and within a few months it becomes part of the heart.

After the op I came round in the recovery room and felt ok albeit groggy. My leg bled for about 30 minutes which was in part due to the anti-coagulants they'd given me during the op. Once they were comfortable the bleeding had stopped and that my ECG and blood pressure was good I was moved back to the ward. Over the next 4 hours I was closely monitored to make sure all was well. The cardiologist visited and carried out an ultrasound and I could actually see my heart beating with the device visible on screen.

Within a couple of hours I was sat up and eating and 4 hours post op I was allowed to get up. I was then checked the day after the op again by ultrasound to confirm the device was well placed and that there was still no visible issues to the heart i.e. blood or fluid build up.

For the week post the op I can't drive and I'm off work. Main risk is actually the vein in my leg rather than my heart. After 4 weeks I'm considered OK and allowed back to the gym and most activities. Proper deco diving is at least 3 months and bubble test away. Possible side-effects. Well it is a low risk op but not a no-risk op. Surgery risks include damage to throat from the probe, damage to the vein or artery in the leg, damage to the heart. Post op the risks are the device coming free, slightly higher risk of ****** (mitigated by anti-coagulants) for the first few weeks, migraines and heart arrythmia. However these are all low risk events.

I'm currently feeling a little sore but I'm hopeful that the decision to have this done will be borne out. Success rate of the ops is somewhere near 95-98% dependent on studies so I'm reasonably hopeful I'll get a pass back to diving early next year.

Cheers
Al

GLOC · December 13th, 2006, 01:47 AM

Good luck Al, and hope the recover goes to plan.

**jb2cool** · December 13th, 2006, 08:59 AM

Al, how would one go about getting a PFO test and would it actualy be worthwhile getting tested now? Did you have the test because of previous problems with deco?

MonkSeal · December 13th, 2006, 09:11 AM

Al, thanks for sharing this. Your case made me test PFO few days after your deco accident. Best wishes for fast recovery.

Ali Fikree · December 13th, 2006, 09:57 AM

Quote: (Originally Posted by jb2cool)

Al, how would one go about getting a PFO test and would it actualy be worthwhile getting tested now? Did you have the test because of previous problems with deco?

Also, do you know if it covered by insurance? I have been trying to arrange one for a few months now but have been given the run around by insurance.

-Ali

graham_hk · December 13th, 2006, 10:50 AM

Bloody hell Al - you're braver than me. Before my buddy and I had our TEEs we had long conversations about what to do if we were teabags - we decided sell all the dive gear (I even bought some fishing stuff just in case). Luckily we were all clear (I have a good doc here in Phils if anybody is interested).

Incidently I would imagine that the more serious/agressive your diving becomes the more important it is to get tested. I dragged my feet (2000+dives upto 100m) though.

Graham

A-M · December 13th, 2006, 12:14 PM

Glad to hear you're already back home!

It depends on the country/health system if they cover the tee-test or not. In Belgium you can ask for one without any additional costs. The operation on the other hand you will have to pay for yourself partly because 'there is no immediate medical condition that asks for that specific operation'.....

Ahmed Adly, Marlin Inn DC · December 13th, 2006, 12:19 PM

Although it freaked me out, thanks for the post. It was actually about the most educating diving related posts out there.

fraser · December 13th, 2006, 03:21 PM

Agree with Ahmed, this is a great post cheers mate. I'll re read it after lunch as I'm feeling decidedly queasy

Can't positive rep you so you'll have to have a 'virtual' one.

Hope you are getting plenty of tea made and the daytime TV is bearable

Frase.

**Alastair** · December 13th, 2006, 09:07 PM

In terms of getting the test done it depends on which country you are in. In the UK I'm led to believe you'd struggle to get the test done on the NHS unless you'd suffered DCS, most people only bother after issues. However you can get it done privately and pay for it yourself if you want which avoids any question on whether it's viable or not. I know of one BSAC club who decided to all get tested after a couple of their members found PFO's.

In my case I got my GP to refer me based on my DCS episode and then got BUPA (private health cover) to then pay for it which meant it happened within a fortnight. I know of someone else who's been referred by their GP but has now been waiting 5 months for the test on the NHS.

Should you get the test if you've had no problems? The general advice from the guy who wrote the book on PFO tests in the UK is - if you have a history of migraine with aura then there may be a risk of DCI and a PFO test can be advised. In the abscence of a history of migraine with aura or an unexplained DCI there is no medical indication that a PFO test would be beneficial.

In my view it comes down to what sort of diving you are doing. Tech-2 level dives then yes it's probably sensible as you are doing bigger dives with more deco. After all what's the downside of knowing one way or the other?

Cheers
Al

BTW - Graham, it was a very difficult decision. Hopefully I've made the right choice

December 13th, 2006, 12:17 AM	#1 (permalink)
Alastair(Offline) DIRX Supporter Join Date: Nov 2005 Location: UK Posts: 693	PFO Closure Well I'm back at home now after my PFO closure. I thought there might be a bit of interest in the op so I figured I'd post up some detail. Essentially a flap of tissue in the heart has failed to seal up and this allows bubbles which would normally be filtered by the lungs to bypass the filter mechanism and carry on to the body. A bit of background on PFO's can be found below: gue.com/Research/Exercise/q3_1j.htm I had my op done privately in the UK which meant I bypassed the normal NHS waiting lists and only had to wait a few weeks between the test and the closure. I checked into hospital and spent several hours meeting various medical staff - anaesthetist, cardiologist, cardiac nurse, pharmacist etc. By the time I got to the operating theatre and met the full team of 10 people who would be working on me I was very nervous and questioning my sanity in agreeing! There was a person for every task - a radiologist, an ultrasound specialist, anaestheist, cardiologist, cardiac nurses, etc. The procedure was done under a general anaesthetic as they needed to put an ultrasound probe down my throat to help them see what was going on. In order to make sure this didn't cause issues they wanted to put a tube down my throat to help me breathe as well. They put a needle into the back of my hand and I drifted off at that point. To install the device they access the venous system through the femoral vein and thread a catheter all the way up to the heart. They then have to use the catheter probe to measure the size of the opening. 5mm in my case. They thread the catheter through the hole to the other side of the heart to create a guideline. This is used to guide the device itself through the opening where one side is opened and the device is positioned. Once in right place the other side is opened like so: This creates a seal but on top of that tissue grows over the device and within a few months it becomes part of the heart. After the op I came round in the recovery room and felt ok albeit groggy. My leg bled for about 30 minutes which was in part due to the anti-coagulants they'd given me during the op. Once they were comfortable the bleeding had stopped and that my ECG and blood pressure was good I was moved back to the ward. Over the next 4 hours I was closely monitored to make sure all was well. The cardiologist visited and carried out an ultrasound and I could actually see my heart beating with the device visible on screen. Within a couple of hours I was sat up and eating and 4 hours post op I was allowed to get up. I was then checked the day after the op again by ultrasound to confirm the device was well placed and that there was still no visible issues to the heart i.e. blood or fluid build up. For the week post the op I can't drive and I'm off work. Main risk is actually the vein in my leg rather than my heart. After 4 weeks I'm considered OK and allowed back to the gym and most activities. Proper deco diving is at least 3 months and bubble test away. Possible side-effects. Well it is a low risk op but not a no-risk op. Surgery risks include damage to throat from the probe, damage to the vein or artery in the leg, damage to the heart. Post op the risks are the device coming free, slightly higher risk of ****** (mitigated by anti-coagulants) for the first few weeks, migraines and heart arrythmia. However these are all low risk events. I'm currently feeling a little sore but I'm hopeful that the decision to have this done will be borne out. Success rate of the ops is somewhere near 95-98% dependent on studies so I'm reasonably hopeful I'll get a pass back to diving early next year. Cheers Al __________________ Helium is our friend - GI3

December 13th, 2006, 01:47 AM	#2 (permalink)
GLOC (Online) Moderator Join Date: Nov 2005 Location: Fleet, Hants Posts: 1,950	Good luck Al, and hope the recover goes to plan. __________________ Gareth Images of Life Photography DIR Team Foxturd Travels Underwater and Further Afar If you don't have the time to do something right, where are you going to find the time to fix it? - Stephen King

December 13th, 2006, 08:59 AM	#3 (permalink)
jb2cool (Online) Padawan learner Join Date: Nov 2005 Location: Bracknell, Berkshire Posts: 796	Al, how would one go about getting a PFO test and would it actualy be worthwhile getting tested now? Did you have the test because of previous problems with deco? __________________ http://jb2cool.bulldoghome.com

December 13th, 2006, 10:50 AM	#6 (permalink)
graham_hk(Offline) Pinoy ako pinoy Join Date: Nov 2005 Location: here, there and everywhere Posts: 779	Bloody hell Al - you're braver than me. Before my buddy and I had our TEEs we had long conversations about what to do if we were teabags - we decided sell all the dive gear (I even bought some fishing stuff just in case). Luckily we were all clear (I have a good doc here in Phils if anybody is interested). Incidently I would imagine that the more serious/agressive your diving becomes the more important it is to get tested. I dragged my feet (2000+dives upto 100m) though. Graham __________________ DIN caps and plugs with free world wide postage: www.dustcap.halcyon-hk.com

December 13th, 2006, 12:19 PM	#8 (permalink)
Ahmed Adly, Marlin Inn DC(Offline) New Member Join Date: Feb 2006 Location: hurghada Posts: 849	Although it freaked me out, thanks for the post. It was actually about the most educating diving related posts out there. __________________ It has just dawned on me.... We are all just recycled stardust Ahmed Adly, www.deepvoyage.com

December 13th, 2006, 09:11 AM	#4 (permalink)
MonkSeal(Offline) Old Member Join Date: Feb 2006 Location: Zagreb, Croatia Posts: 472	Al, thanks for sharing this. Your case made me test PFO few days after your deco accident. Best wishes for fast recovery.

December 13th, 2006, 09:57 AM	#5 (permalink)
Ali Fikree (Online) New Member Join Date: Dec 2005 Location: Dubai Posts: 460	Quote: (Originally Posted by jb2cool) Al, how would one go about getting a PFO test and would it actualy be worthwhile getting tested now? Did you have the test because of previous problems with deco? Also, do you know if it covered by insurance? I have been trying to arrange one for a few months now but have been given the run around by insurance. -Ali

December 13th, 2006, 12:14 PM	#7 (permalink)
A-M(Offline) Cave addict Join Date: Dec 2005 Location: Netherlands Posts: 370	Glad to hear you're already back home! It depends on the country/health system if they cover the tee-test or not. In Belgium you can ask for one without any additional costs. The operation on the other hand you will have to pay for yourself partly because 'there is no immediate medical condition that asks for that specific operation'.....

December 13th, 2006, 03:21 PM	#9 (permalink)
fraser(Offline) "I'm only late on your timescale" Join Date: Nov 2005 Location: Kent, UK Posts: 463	Agree with Ahmed, this is a great post cheers mate. I'll re read it after lunch as I'm feeling decidedly queasy Can't positive rep you so you'll have to have a 'virtual' one. Hope you are getting plenty of tea made and the daytime TV is bearable Frase. __________________ Damn it feels good to be a gangsta

December 13th, 2006, 09:07 PM	#10 (permalink)
Alastair(Offline) DIRX Supporter Join Date: Nov 2005 Location: UK Posts: 693	In terms of getting the test done it depends on which country you are in. In the UK I'm led to believe you'd struggle to get the test done on the NHS unless you'd suffered DCS, most people only bother after issues. However you can get it done privately and pay for it yourself if you want which avoids any question on whether it's viable or not. I know of one BSAC club who decided to all get tested after a couple of their members found PFO's. In my case I got my GP to refer me based on my DCS episode and then got BUPA (private health cover) to then pay for it which meant it happened within a fortnight. I know of someone else who's been referred by their GP but has now been waiting 5 months for the test on the NHS. Should you get the test if you've had no problems? The general advice from the guy who wrote the book on PFO tests in the UK is - if you have a history of migraine with aura then there may be a risk of DCI and a PFO test can be advised. In the abscence of a history of migraine with aura or an unexplained DCI there is no medical indication that a PFO test would be beneficial. In my view it comes down to what sort of diving you are doing. Tech-2 level dives then yes it's probably sensible as you are doing bigger dives with more deco. After all what's the downside of knowing one way or the other? Cheers Al BTW - Graham, it was a very difficult decision. Hopefully I've made the right choice __________________ Helium is our friend - GI3