联合立场声明心房分流(持续[未闭]卵圆孔和房间隔缺损)和跳水:2025年更新。南太平洋水下医学协会(SPUMS)和英国潜水医学委员会(UKDMC)。

IF 0.8 4区 医学 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
David Smart, Peter Wilmshurst, Neil Banham, Mark Turner, Simon J Mitchell
{"title":"联合立场声明心房分流(持续[未闭]卵圆孔和房间隔缺损)和跳水:2025年更新。南太平洋水下医学协会(SPUMS)和英国潜水医学委员会(UKDMC)。","authors":"David Smart, Peter Wilmshurst, Neil Banham, Mark Turner, Simon J Mitchell","doi":"10.28920/dhm55.1.51-55","DOIUrl":null,"url":null,"abstract":"<p><p>This consensus statement is the product of a workshop at the South Pacific Underwater Medicine Society Annual Scientific Meeting 2024 with representation of the United Kingdom Diving Medical Committee (UKDMC) present, and subsequent discussions included the entire UKDMC. A large right-to-left shunt across a persistent (patent) foramen ovale (PFO), an atrial septal defect (ASD) or a pulmonary shunt is a risk factor for some types of decompression sickness (DCS). It is agreed that routine screening for a right-to-left shunt is not currently justifiable, but certain high risk sub-groups can be identified. Individuals with a history of cerebral, spinal, vestibulocochlear, cardiovascular or cutaneous DCS, migraine with aura or cryptogenic stroke; a family history of PFO or ASD and individuals with other forms of congenital heart disease have a higher prevalence, and for those individuals screening should be considered. If screening is undertaken, it should be by bubble contrast transthoracic echocardiography with provocative manoeuvres (including Valsalva release and sniffing). Appropriate quality control is important. If a shunt is present, advice should be provided by an experienced diving physician taking into account the clinical context and the size of shunt. If shunt-mediated DCS is diagnosed, the safest option is to stop diving. Another is to perform dives with restrictions to reduce the inert gas load, which is facilitated by limiting depth and duration of dives, breathing a gas with a lower percentage of nitrogen and reducing repetitive diving. Divers may consider transcatheter device closure of the PFO or ASD in order to return to normal diving. If transcatheter PFO or ASD closure is undertaken, repeat bubble contrast echocardiography must be performed to confirm adequate reduction or abolition of the right-to-left shunt, and the diver should have stopped taking potent anti-platelet therapy (low dose aspirin is acceptable) before resuming diving.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 1","pages":"51-55"},"PeriodicalIF":0.8000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043516/pdf/","citationCount":"0","resultStr":"{\"title\":\"Joint position statement on atrial shunts (persistent [patent] foramen ovale and atrial septal defects) and diving: 2025 update. South Pacific Underwater Medicine Society (SPUMS) and the United Kingdom Diving Medical Committee (UKDMC).\",\"authors\":\"David Smart, Peter Wilmshurst, Neil Banham, Mark Turner, Simon J Mitchell\",\"doi\":\"10.28920/dhm55.1.51-55\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>This consensus statement is the product of a workshop at the South Pacific Underwater Medicine Society Annual Scientific Meeting 2024 with representation of the United Kingdom Diving Medical Committee (UKDMC) present, and subsequent discussions included the entire UKDMC. A large right-to-left shunt across a persistent (patent) foramen ovale (PFO), an atrial septal defect (ASD) or a pulmonary shunt is a risk factor for some types of decompression sickness (DCS). It is agreed that routine screening for a right-to-left shunt is not currently justifiable, but certain high risk sub-groups can be identified. Individuals with a history of cerebral, spinal, vestibulocochlear, cardiovascular or cutaneous DCS, migraine with aura or cryptogenic stroke; a family history of PFO or ASD and individuals with other forms of congenital heart disease have a higher prevalence, and for those individuals screening should be considered. If screening is undertaken, it should be by bubble contrast transthoracic echocardiography with provocative manoeuvres (including Valsalva release and sniffing). Appropriate quality control is important. If a shunt is present, advice should be provided by an experienced diving physician taking into account the clinical context and the size of shunt. If shunt-mediated DCS is diagnosed, the safest option is to stop diving. Another is to perform dives with restrictions to reduce the inert gas load, which is facilitated by limiting depth and duration of dives, breathing a gas with a lower percentage of nitrogen and reducing repetitive diving. Divers may consider transcatheter device closure of the PFO or ASD in order to return to normal diving. If transcatheter PFO or ASD closure is undertaken, repeat bubble contrast echocardiography must be performed to confirm adequate reduction or abolition of the right-to-left shunt, and the diver should have stopped taking potent anti-platelet therapy (low dose aspirin is acceptable) before resuming diving.</p>\",\"PeriodicalId\":11296,\"journal\":{\"name\":\"Diving and hyperbaric medicine\",\"volume\":\"55 1\",\"pages\":\"51-55\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2025-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043516/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diving and hyperbaric medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.28920/dhm55.1.51-55\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diving and hyperbaric medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.28920/dhm55.1.51-55","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0

摘要

这份共识声明是南太平洋水下医学学会年度科学会议2024年研讨会的产物,英国潜水医学委员会(UKDMC)的代表出席了会议,随后的讨论包括整个UKDMC。从右到左的大分流穿过持续性(未闭)卵圆孔(PFO)、房间隔缺损(ASD)或肺分流是某些类型减压病(DCS)的危险因素。人们一致认为,目前对右至左分流的常规筛查是不合理的,但可以确定某些高风险亚组。有脑、脊髓、前庭耳蜗、心血管或皮肤DCS病史、先兆偏头痛或隐源性中风病史者;有PFO或ASD家族史以及患有其他形式先天性心脏病的个体患病率较高,对于这些个体应考虑筛查。如果进行筛查,应通过气泡造影剂经胸超声心动图进行刺激操作(包括Valsalva释放和嗅探)。适当的质量控制很重要。如果存在分流器,应由经验丰富的潜水医生根据临床情况和分流器的大小提供建议。如果诊断为分流介导的DCS,最安全的选择是停止潜水。另一种方法是在限制条件下进行潜水,以减少惰性气体负荷,这可以通过限制潜水深度和潜水时间、呼吸含氮比例较低的气体和减少重复潜水来实现。潜水员可以考虑使用经导管装置关闭PFO或ASD,以便恢复正常潜水。如果进行了经导管PFO或ASD关闭,必须进行重复气泡造影超声心动图以确认右至左分流的充分减少或消除,并且潜水员在恢复潜水之前应该停止服用有效的抗血小板治疗(低剂量阿司匹林是可以接受的)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Joint position statement on atrial shunts (persistent [patent] foramen ovale and atrial septal defects) and diving: 2025 update. South Pacific Underwater Medicine Society (SPUMS) and the United Kingdom Diving Medical Committee (UKDMC).

This consensus statement is the product of a workshop at the South Pacific Underwater Medicine Society Annual Scientific Meeting 2024 with representation of the United Kingdom Diving Medical Committee (UKDMC) present, and subsequent discussions included the entire UKDMC. A large right-to-left shunt across a persistent (patent) foramen ovale (PFO), an atrial septal defect (ASD) or a pulmonary shunt is a risk factor for some types of decompression sickness (DCS). It is agreed that routine screening for a right-to-left shunt is not currently justifiable, but certain high risk sub-groups can be identified. Individuals with a history of cerebral, spinal, vestibulocochlear, cardiovascular or cutaneous DCS, migraine with aura or cryptogenic stroke; a family history of PFO or ASD and individuals with other forms of congenital heart disease have a higher prevalence, and for those individuals screening should be considered. If screening is undertaken, it should be by bubble contrast transthoracic echocardiography with provocative manoeuvres (including Valsalva release and sniffing). Appropriate quality control is important. If a shunt is present, advice should be provided by an experienced diving physician taking into account the clinical context and the size of shunt. If shunt-mediated DCS is diagnosed, the safest option is to stop diving. Another is to perform dives with restrictions to reduce the inert gas load, which is facilitated by limiting depth and duration of dives, breathing a gas with a lower percentage of nitrogen and reducing repetitive diving. Divers may consider transcatheter device closure of the PFO or ASD in order to return to normal diving. If transcatheter PFO or ASD closure is undertaken, repeat bubble contrast echocardiography must be performed to confirm adequate reduction or abolition of the right-to-left shunt, and the diver should have stopped taking potent anti-platelet therapy (low dose aspirin is acceptable) before resuming diving.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Diving and hyperbaric medicine
Diving and hyperbaric medicine 医学-公共卫生、环境卫生与职业卫生
CiteScore
1.70
自引率
22.20%
发文量
37
审稿时长
>12 weeks
期刊介绍: Diving and Hyperbaric Medicine (DHM) is the combined journal of the South Pacific Underwater Medicine Society (SPUMS) and the European Underwater and Baromedical Society (EUBS). It seeks to publish papers of high quality on all aspects of diving and hyperbaric medicine of interest to diving medical professionals, physicians of all specialties, scientists, members of the diving and hyperbaric industries, and divers. Manuscripts must be offered exclusively to Diving and Hyperbaric Medicine, unless clearly authenticated copyright exemption accompaniesthe manuscript. All manuscripts will be subject to peer review. Accepted contributions will also be subject to editing.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信