>Yes, there are dopler studies and some dye studies that could make the 
>determination; however, most physicans wouldn't run the studies absent 
>sympthoms.  Perhaps they might run the studies for someone doing deep, 
>deco dives if they really understand diving medicine, otherwise, I doubt 
>you'll find one willing.

I agree. I'm from the "If it ain't broke... don't fix it" school of 
medicine. If a patient has a *functional* PFO they will be symptomatic 
already (would have been from birth). If it hasn't already been 
surgically repaired, the higher pressures that the lungs will have been 
subjected to over the years will have caused pulmonary hypertension with 
it's vascular changes and deterioration of pulmonary function. The 
patient would not be a dive candidate anyway.

Now, if they have a probe patent FO with *no* functional cross flow, 
what's to fix? Physicians are generally hesitant to perform tests that 
don't help to distinguish a course of *therapy*. What therapy would you 
give an *asymptomatic* patient? (insurance companies hesitancy to pay for 
tests on "non-patients" may have something to do with it too, I'm sure. 
But as a military doc I thankfully plead ignorance to these commercial 
matters). 

Would you as a surgeon, subject a *symptomless* patient to the risks of 
open heart surgery, anesthesia, infection, blood tranfusion 
incompatibilities and the like (no matter if statistically small) just so 
a lab report looks prettier? I doubt it. Assuming you are feeling great 
and have been diving without incident for years, would you subject 
yourself to such risks if I came to you and said, "Oh, by the way, for 
your interest, we found this pin-hole sized hole inside your heart. 
Nothings going through it, but it's there. When can we schedule you for 
the OR?" You'd think I was nuts (and you'd be right!)

I checked Jolie Bookspans book last night to see what she says on PFO's. 
While she acknowledges that *asymptomatic* PFO's *theoretically* can 
contribute to DCI, so far this has not been documented.

While I'm *not* advocating ignoring this issue (these questions must be 
asked so that the limits of diving medicine can be pushed) I don't see 
anything yet to lose sleep over *in the asymptomatic diver*. Otherwise I 
can write a paper on a *new* condition "Dysbaric Hypochondiasis".
Yea! That's the ticket! We'll call it "Wolov's Syndrome"

;-)

Take care

Robb Wolov

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