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Thread: PFO Test

  1. #31
    Quote Originally Posted by iainmsmith View Post
    Define "insensitive" and "superior".

    I would consult medical literature (using good skills in critical appraisal) to compare the "accuracy" of diagnostic tests or take advice from a specialist, rather than relying on a diving textbook. Many tests are extremely context-sensitive, as illustrated by other posters.

    Iain
    Iain - you are a medic - why don't you get online and search it out? After all, you are one of the few on this forum who could do this and provide some useful information rather than argue semantics.

    For the layman I would imagine the chosen language is useful - how about some numbers from you?

    Graham
    ah herro

  2. #32
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    Quote Originally Posted by graham_hk View Post
    Iain - you are a medic - why don't you get online and search it out? After all, you are one of the few on this forum who could do this and provide some useful information rather than argue semantics.

    For the layman I would imagine the chosen language is useful - how about some numbers from you?

    Graham
    Sensitivity and specificity - Wikipedia, the free encyclopedia

    Sensitivity and Specificity - Medpedia

    Tobin

  3. #33

    To confuse everybody

    Hi Guys,

    I know it's an old thread but I need to say this. Have a look here: can't post URL because of the rule of the forum If you need the link I can give it to you by email.

    Those guys (paper published in 2008) argue that TTE is as good as TEE/TOE. I don't want to go into details because I am not entirely sure what I am talking about (I'm a theoretical physicist not a medical doctor) and it seems that nowadays they do TTE with some special analysis of the received signals, which might not have been done before.

    What I want to say is that when you do any kind of research (I am regularly publishing scientific papers so I know something about the process) in the area where data is sparse or it's difficult to analyse a given system, opinions are divided and, in the end, nobody knows what is going on.

    So, my take is the following one: If you have a positive result for PFO regardless of the method then you are positive. However, if you are negative then the probabilistic nature of the world kicks in and you basically take chances.

  4. #34
    Let me start out with: Sorry for resurrecting this old thread, but there was already some information in here that I deemed relevant.

    I've been doing some reading lately (and will be meeting with a cardiologist) to test for a PFO.
    Now, there was this recommendation of doing literature research to figure out what's best. And that's where things got interesting (btw. all this was published after this thread "ended").

    TCD is better than TEE for Diagnosis of PFO (2014): http://www.medscape.com/viewarticle/820702
    TEE better than TTE (2005): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1768819/
    TTE detects more than TEE or TCD (2011): https://www.ncbi.nlm.nih.gov/pubmed/21277667

    So, there is a paper to show that every one of them is the best

    Now, there is quite a bit of literature stating that TEE detects more than TTE, but a lot of that seems to be older than the above (e.g., https://www.ncbi.nlm.nih.gov/pubmed/1510018 from 1992, or the above from 2005).

    Was there some advancement in the imaging quality by TTE that makes this the better choice nowadays? Or should one do a TCD to detect all shunts, and then do a TTE/TEE to diagnose a PFO in case there is one (basically, decide if it is fixable)?

    I have found that there are two types of TEE: 2d and 3d. For 2D, it seems as if a lot would depend on the skill of the examiner.

  5. #35
    unfortunately, TEE will only show shunts in your heart, some divers also have shunts in their lungs which can only be detected by a TCD.
    The TCD, although extremely accurate is useless for locating a shunt though.

    Michael

  6. #36
    That part is clear. Are those other shunts likely transient? Or is there no proven connection between those shunts and DCS incidents?

    The ignorance regarding the second question has always dumbfounded me.

  7. #37
    Quote Originally Posted by data2 View Post
    That part is clear. Are those other shunts likely transient? Or is there no proven connection between those shunts and DCS incidents?

    The ignorance regarding the second question has always dumbfounded me.
    It's not as clear as it should be. I remember reading about a female tech diving Instructor diving at the northern end of Lake Garda, Italy, that after getting a PFO fixed, continued to have DCS II incidents that were finally attributed to a lung shunt.
    It's also possible that Tamara Kendel, an ex GUE C2 Instructor finally gave up diving for the same reason.
    Unfortunatly the pool of Tech divers with proven lung or other shunts that aren't caused by a PFO is very small, possibly caused by diagnostic failures, or by the affected dropping out of diving before a diagnosis has been made.

    Michael

 

 
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