Patent Foramen Ovale Closure and Decompression Sickness Among Divers

Omar M. Abdelfattah, Ahmed Sayed, Islam Y. Elgendy, Malak Munir, Yehia Saleh, Samir R. Kapadia, George S. Abela, Hani Jneid

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Decompression sickness is a diving-related disease that results in various clinical manifestations, ranging from joint pain to severe pulmonary and CNS affection. Complications of this disease may sometimes persist even after treatment with hyperbaric oxygen therapy. In addition, it may hamper the quality of life by forcing divers to restrict their recreational practice. The presence of a patent foramen ovale (PFO) increases the risk of decompression sickness by facilitating air embolization. Therefore, PFO closure may play a role in reducing such complications. However, PFO closure remains associated with its own set of risks and complications. We sought to assess the benefit and harm of PFO closure for the prevention of decompression sickness in divers. Methods: We conducted a comprehensive search of MEDLINE, Embase, CENTRAL, and Web of Science. Two-armed studies comparing the incidence of decompression sickness with or without PFO closure were included. We used a random-effects model to compute risk ratios comparing groups undergoing PFO closure to those not undergoing PFO closure. Results: Four observational studies with a total of 309 divers (PFO closure: 141 and no closure: 168) met inclusion criteria. PFO closure was associated with a significantly lower incidence of decompression sickness (PFO-closure: 2.84%; no closure: 11.3%; RR: 0.29; 95% CI: 0.10 to 0.89; NNTB = 11), with low heterogeneity (I2 = 0%). The mean follow-up was 6.12 years (Standard deviation 0.70). Adverse events occurred in 7.63% of PFO closures, including tachyarrhythmias and bleeding. Conclusion: PFO closure may potentially reduce the risk of decompression sickness among divers; however, it is not free of potential downsides, with nearly one in thirteen patients in our analysis experiencing an adverse event.

Original languageEnglish (US)
Pages (from-to)160-162
Number of pages3
JournalCardiovascular Revascularization Medicine
StatePublished - Jul 2022
Externally publishedYes


  • Closure
  • Complications
  • Decompression sickness
  • Divers
  • Outcomes
  • Patent foramen ovale
  • meta-analysis
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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