{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:16:47Z","timestamp":1791415007014,"version":"4.3.3"},"reference-count":36,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2015,2,19]],"date-time":"2015-02-19T00:00:00Z","timestamp":1424304000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Marie Curie actions, FP7, PHYPODE","award":["264816"],"award-info":[{"award-number":["264816"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:p>Laboratory and field investigations have demonstrated that intrapulmonary arteriovenous anastomoses (IPAVA) may provide an additional means for venous gas emboli (VGE) to cross\u00a0over to the arterial circulation due to their larger diameter compared to pulmonary microcirculation. Once thought to be the primary cause of decompression sickness (DCS), it has been demonstrated that, even in large quantities, their presence does not always result in injury. Normally, VGE are trapped in the site of gas exchange in the lungs and eliminated via diffusion. When VGE crossover takes place in arterial circulation, they have the potential to cause more harm as they are redistributed to the brain, spinal column, and other sensitive tissues. The patent foramen ovale (PFO) was once thought to be the only risk factor for an increase in arterialization; however, IPAVAs represent another pathway for this crossover to occur. The opening of IPAVAs is associated with exercise and hypoxic gas mixtures, both of which divers may encounter. The goal of this review is to describe how IPAVAs may impact diving physiology, specifically during decompression, and what this means for the individual diver as well as the future of commercial and recreational diving. Future research must continue on the relationship between IPAVAs and the environmental and physiological circumstances that lead to their opening and closing, as well as how they may contribute to diving injuries such as DCS.<\/jats:p>","DOI":"10.1111\/echo.12815","type":"journal-article","created":{"date-parts":[[2015,2,19]],"date-time":"2015-02-19T06:33:34Z","timestamp":1424327614000},"source":"Crossref","is-referenced-by-count":19,"title":["Intrapulmonary Shunt and SCUBA Diving: Another Risk Factor?"],"prefix":"10.1111","volume":"32","author":[{"given":"Dennis","family":"Madden","sequence":"first","affiliation":[{"name":"Department of Integrative Physiology University of Split School of Medicine Split Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Ljubkovic","sequence":"additional","affiliation":[{"name":"Department of Integrative Physiology University of Split School of Medicine Split Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeljko","family":"Dujic","sequence":"additional","affiliation":[{"name":"Department of Integrative Physiology University of Split School of Medicine Split Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,2,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1990.69.3.914"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e31820618d3"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2004.04.028"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61085-9"},{"key":"e_1_2_9_6_1","first-page":"293","article-title":"Agreement between trained and untrained observers in grading intravascular bubble signals in ultrasonic images","volume":"24","author":"Eftedal O","year":"1997","journal-title":"Undersea Hyperb Med"},{"key":"e_1_2_9_7_1","first-page":"124","article-title":"Observation of increased venous gas emboli after wet dives compared to dry dives","volume":"41","author":"Mollerlokken A","year":"2011","journal-title":"Diving Hyperb Med"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.314.7082.701"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.52.2.401"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.11.1741"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181aa04cc"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01369.2009"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1985.59.2.543"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00943.2011"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00029.2013"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00137.2004"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.12100"},{"key":"e_1_2_9_18_1","first-page":"1058","article-title":"Association between right\u2010to\u2010left shunts and brain lesions in sport divers","volume":"74","author":"Gerriets T","year":"2003","journal-title":"Aviat Space Environ Med"},{"key":"e_1_2_9_19_1","first-page":"163","article-title":"Size distribution of intravascular air emboli produced by decompression","volume":"8","author":"Hills BA","year":"1981","journal-title":"Undersea Biomed Res"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00208.2007"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2008.159350"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2004.069302"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2012.01.004"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/echo.12360"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.20378"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2003.059360"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/jes.0b013e31815ddb02"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.3357\/ASEM.2588.2010"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.3357\/ASEM.2377.2008"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1249\/01.mss.0000228936.78916.23"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1080\/15438627.2010.490189"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00723.1999"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.3357\/ASEM.3862.2014"},{"key":"e_1_2_9_34_1","first-page":"1","article-title":"Decompression sickness among U.S. Navy Operational Divers: An estimate of incidence using air decompression tables. 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