If you've recently experienced, or been treated for suspected, decompression illness (DCI), and have been informed about the possibility of having a Patent Foramen Ovale (PFO), it's normal to feel a surge of concern. This page was created in response to reports from divers seeking therapy following diving-related incidents.  It was observed that divers who reported feeling distressed after being told they may have a PFO, anxious about what it may mean for them.  Often this improved with basic information about PFOs.

The goal is not to provide medical advice, but to point divers towards reliable and relevant resources.  The page aims to shed light on what a PFO is, why it matters in diving, and what it may mean for your diving. 

Patent Foramen Ovale (PFO)

A common condition of the heart that affects around a quarter of the population.

What is a PFO?

A Patent Foramen Ovale (PFO) is a small hole situated between the two upper chambers of the heart. This hole is crucial in foetal development, allowing blood to bypass the unborn baby's lungs. Usually, it closes after birth when the newborn starts breathing. 

However, in approximately  a quarter of the population, this hole remains open or 'persists', a condition known as a persistent foramen ovale or more commonly, a PFO. This condition is quite common, with an estimated 1 in 4 individuals living with a PFO. Generally, a PFO causes no problems throughout an individual's life and often goes unnoticed.  

1 in 4 people have a PFO

Nevertheless, the presence of a PFO can become a significant concern for individuals involved in scuba diving due to potential complications related to decompression sickness. The specifics of how a PFO can impact a diver's health are complex. You can delve into the details in this informative article provided by the Divers Alert Network.

Dealing with PFO diagnosis

Receiving a diagnosis, or even the possibility of having a PFO, can be a lot to absorb. It's entirely normal if you're experiencing some worrying thoughts and  difficult emotions. You might be asking yourself, "What does this mean for my diving future?" or "How will this affect my health?". These are valid concerns, and you're not alone in having them.

Although a PFO has potential to impact your diving, and this can be difficult, there may be options available to you. Other divers have navigated this and have found ways to continue diving, or deal with changes.

"If you are diagnosed with a PFO there are three potential options; stop diving, dive more conservatively ... or consider a procedure to close the PFO." -DDRC.

Resources available to you may include medical professionals and diving communities alike, who can provide you with support and guidance. There's a network of people who understand your passion for diving and can provide the advice and empathy you need at this moment.


Treatment for PFO

In many instances, a PFO requires no treatment. However, for divers, the presence of a PFO might warrant further consideration.  There are treatment options, including a minimally invasive procedure that is generally considered safe with a low risk of complications, but as with any medical procedure, it's not entirely without risk. Therefore, it is crucial to discuss the risks and benefits with your doctor. It would be advisable to see a cardiologist with an interest in diving. 

In the UK, the NHS does perform PFO closures, but typically only for patients who have health conditions where PFO is considered a significant factor. However, the guidelines are different for divers and vary between NHS trusts. For those where NHS treatment is not an option, private treatment is available. The cost of private PFO closure can be quite high, so this is an important factor to consider.

Overall, the decision to go ahead with PFO closure should be made on an individual basis, after thorough discussion with your medical professional.  They will be able to provide advice that is tailored to your individual health profile and diving aspirations.

Undergoing PFO Surgery

Consider reading this detailed account from two divers undergoing surgery to close their PFOs, and documenting their return to diving. (Contains images from surgery).

PFO: Three Options

The United Kingdom Diving Medical Committee (UKDMC) and the South Pacific Underwater Medical Society (SPUMS) have provided a joint statement offering three options for divers diagnosed with a PFO.

  • Stop Diving

    Having a PFO is known to increase the risks of further diving-related injuries. Some divers choose to stop diving. How this feels as an option for you will depend on many factors, such as the role of diving in your life and social context and your tolerance of risk.

  • Dive More Conservatively

    These are examples of recommended measures for divers diagnosed with a PFO: limiting dive depth to under 15m; keeping dive times well within no decompression limits; planning for a single dive per day; using nitrox while adhering to air diving planning protocols; extending safety stop durations; and refraining from heavy lifting or strenuous activities for a minimum of three hours post-dive.

  • Close The PFO

    Some divers opt for treatment to close the hole. For most people, this is a private treatment and is not usually available via NHS or health insurance. The cost of the procedure will vary, depending on location. Consult with a cardiologist who specialises in diving to review the options and risks.