{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:18:09Z","timestamp":1791397089538,"version":"4.3.3"},"reference-count":25,"publisher":"BMJ","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"accepted":{"date-parts":[[2011,8,4]]},"published-print":{"date-parts":[[2011,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To test the effect of patent foramen ovale (PFO) closure on neurological events in divers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Prospective, non-randomised, longitudinal three-arm study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Tertiary referral centre.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Population<\/jats:title>\n                  <jats:p>104 scuba divers with a history of major decompression illness (DCI).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>Transcutaneous PFO closure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Baseline and three follow-up examinations with a questionnaire about health status and diving habits\/accidents, transoesophageal echocardiography at baseline for PFO grading, cerebral MRI at all examinations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>39 divers had no PFO, 26 had a PFO and chose to undergo percutaneous closure and 39 had a PFO, but decided not to undergo closure. The total number of dives, including those performed before baseline and those during long-term follow-up, was 81\u2008654; 18\u2008394 dives during the follow-up period of 5.3\u00b10.3\u2005years, during which there were a total of five major neurological DCI events\u2013namely 0 in the no PFO group, 0.5\u00b12.5\/10<jats:sup>4<\/jats:sup> dives in the PFO closure group and 35.8\u00b1102.5\/10<jats:sup>4<\/jats:sup> dives in the PFO no closure group (four events; p=0.045 between the PFO groups). In the groups, no PFO, PFO closure and PFO no closure, there were 1.1\u00b12.6, 0.8\u00b11.4, 3.3\u00b16.9 ischaemic brain lesions, respectively, at follow-up (p=0.039 between the PFO groups)\u2014that is, 16\u00b142\/10<jats:sup>4<\/jats:sup> dives in the no PFO group, 6\u00b113\/10<jats:sup>4<\/jats:sup> dives in the PFO closure group and 104\u00b1246\/10<jats:sup>4<\/jats:sup> dives in the PFO no closure group (overall p=0.042; p=0.024 between the PFO groups).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>PFO closure in continuing divers appears to prevent symptomatic (major DCI) and asymptomatic (ischaemic brain lesions) neurological events during long-term follow-up.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2011-300436","type":"journal-article","created":{"date-parts":[[2011,9,15]],"date-time":"2011-09-15T03:40:49Z","timestamp":1316058049000},"page":"1932-1937","source":"Crossref","is-referenced-by-count":84,"title":["Patent foramen ovale closure in recreational divers: effect on decompression illness and ischaemic brain lesions during long-term follow-up"],"prefix":"10.1136","volume":"97","author":[{"given":"Michael","family":"Billinger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Zbinden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaela","family":"Mordasini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Windecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Schwerzmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Meier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Seiler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2011,9,13]]},"reference":[{"key":"2025091923462820000_97.23.1932.1","doi-asserted-by":"publisher","DOI":"10.1063\/1.330564"},{"key":"2025091923462820000_97.23.1932.2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00208.2007"},{"key":"2025091923462820000_97.23.1932.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)60336-X"},{"key":"2025091923462820000_97.23.1932.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.293.6557.1277"},{"key":"2025091923462820000_97.23.1932.5","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S0140-6736(89)90064-0","article-title":"Patent foramen ovale and decompression sickness in divers","volume":"1","author":"Moon","year":"1989","journal-title":"Lancet"},{"key":"2025091923462820000_97.23.1932.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(89)91911-9"},{"key":"2025091923462820000_97.23.1932.7","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1152\/jappl.1998.84.5.1622","article-title":"Patent foramen ovale and decompression sickness in sports divers","volume":"84","author":"Germonpr\u00e9","year":"1998","journal-title":"J Appl Physiol"},{"key":"2025091923462820000_97.23.1932.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.12.026"},{"key":"2025091923462820000_97.23.1932.9","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1038844"},{"key":"2025091923462820000_97.23.1932.10","first-page":"175","article-title":"Risk of decompression sickness with patent foramen ovale","volume":"25","author":"Bove","year":"1998","journal-title":"Undersea Hyperb Med"},{"key":"2025091923462820000_97.23.1932.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2004.04.028"},{"key":"2025091923462820000_97.23.1932.12","doi-asserted-by":"crossref","first-page":"21","DOI":"10.7326\/0003-4819-134-1-200101020-00009","article-title":"Relation between directly detected patent foramen ovale and ischemic brain lesions in sport divers","volume":"134","author":"Schwerzmann","year":"2001","journal-title":"Ann Intern Med"},{"key":"2025091923462820000_97.23.1932.13","unstructured":"Elliott DH Moon RE . 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