{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T03:12:17Z","timestamp":1771643537253,"version":"3.50.1"},"reference-count":0,"publisher":"Diving and Hyperbaric Medicine Journal","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diving Hyperb Med"],"abstract":"<jats:p>The case of a diver with a history of decompression sickness (DCS) after recreational scuba diving is presented. Cutis marmorata, a subtype of cutaneous DCS, has been consistently associated with the presence of a persistent (patent) foramen ovale (PFO) as a risk factor. Diagnostic uncertainty arose when transthoracic echocardiography with antecubital injection of agitated saline bubbles (ASBs) did not show any significant shunt, but the presence of a large Eustachian valve was counteracted by intra-femoral injection of ASBs, showing a large PFO with spontaneous shunting. The importance of proper echocardiography techniques prior to resorting to intra-femoral injection of ASBs to counteract the haemodynamic effects of the Eustachian valve is emphasised.<\/jats:p>","DOI":"10.28920\/dhm51.1.98-102","type":"journal-article","created":{"date-parts":[[2021,3,28]],"date-time":"2021-03-28T20:20:57Z","timestamp":1616962857000},"page":"98-102","source":"Crossref","is-referenced-by-count":2,"title":["Echocardiography \u2013 techniques and pitfalls whilst diagnosing persistent (patent) foramen ovale as a risk factor in divers with a history of decompression sickness"],"prefix":"10.28920","volume":"51","author":[{"name":"Baromedicine Department, Hyperbaric Unit, Mater Dei Hospital, Malta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles P","family":"Azzopardi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kurt","family":"Magri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Baromedicine Department, Hyperbaric Unit, Mater Dei Hospital, Malta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Borg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Cardiology Department, Mater Dei Hospital, Malta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jake","family":"Schembri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Mater Dei Hospital, Malta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Sammut","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Mater Dei Hospital, Malta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"11463","published-online":{"date-parts":[[2021,3,31]]},"container-title":["Diving and Hyperbaric Medicine Journal"],"original-title":[],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:24:57Z","timestamp":1765499097000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.dhmjournal.com\/images\/IndividArticles\/51March\/Azzopardi_EchoPFO_2020-68(705).pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,31]]},"references-count":0,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,3,31]]}},"URL":"https:\/\/doi.org\/10.28920\/dhm51.1.98-102","relation":{},"ISSN":["2209-1491"],"issn-type":[{"value":"2209-1491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,31]]}}}