DAN and the Undersea and Hyperbaric Medical Society held a consensus guideline workshop on PFO and diving. However, the high prevalence of PFO in the population and the very low incidence of DCS suggest that a PFO likely plays only a minor role in the pathophysiology of DCS. Several studies suggest that presence of a PFO can increase the risk of serious DCS. Eighteen patients in this cohort had a history of serious DCS, and 11 (61%) of this subgroup had shunting through a PFO. 125 In 30 divers with a history of DCS, Moon and colleagues 121 reported a higher prevalence of PFO (37%). 124 In a contrast echocardiographic study of 76 healthy volunteers, PFO was present in 14 (18%), and 4 (5%) subjects had shunting at rest. 123, 124 In a prospective community-based study of 588 randomly selected subjects, transesophageal echocardiography revealed PFO in 148 subjects (26%) of these, 84 had shunting at rest (57%), and 136 had shunting after Valsalva maneuver or cough (92%). Community-based autopsy and transesophageal studies have revealed the prevalence of PFO at approximately 25%. PFO is an active area of discussion in the diving medical community because of the potential for right-to-left shunting of bubbles. Courtney Broaddus MD, in Murray & Nadel's Textbook of Respiratory Medicine, 2022 Patent Foramen Ovale
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