Inspiratory and expiratory resistance cause right-to-left bubble passage through the foramen ovale

Kayla L Moses; McKayla Seymour; Arij Beshish; Kim R Baker; David F Pegelow; Luke J Lamers; Marlowe W Eldridge; Melissa L Bates

doi:10.14814/phy2.13719

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Inspiratory and expiratory resistance cause right-to-left bubble passage through the foramen ovale

Journal article

Open access

Peer reviewed

Inspiratory and expiratory resistance cause right-to-left bubble passage through the foramen ovale

Kayla L Moses, McKayla Seymour, Arij Beshish, Kim R Baker, David F Pegelow, Luke J Lamers, Marlowe W Eldridge and Melissa L Bates

Physiological reports, Vol.6(12), pp.e13719-n/a

06/2018

DOI: 10.14814/phy2.13719

PMCID: PMC6021277

PMID: 29952137

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Abstract

A patent foramen ovale (PFO) is linked to increased risk of decompression illness in divers. One theory is that venous gas emboli crossing the PFO can be minimized by avoiding lifting, straining and Valsalva maneuvers. Alternatively, we hypothesized that mild increases in external inspiratory and expiratory resistance, similar to that provided by a SCUBA regulator, recruit the PFO. Nine healthy adults with a Valsalva-proven PFO completed three randomized trials (inspiratory, expiratory, and combined external loading) with six levels of increasing external resistance (2-20 cmH O/L/sec). An agitated saline contrast echocardiogram was performed at each level to determine foramen ovale patency. Contrary to our hypothesis, there was no relationship between the number of subjects recruiting their PFO and the level of external resistance. In fact, at least 50% of participants recruited their PFO during 14 of 18 trials and there was no difference between the combined inspiratory, expiratory, or combined external resistance trials (P > 0.05). We further examined the relationship between PFO recruitment and intrathoracic pressure, estimated from esophageal pressure. Esophageal pressure was not different between participants with and without a recruited PFO. Intrasubject variability was the most important predictor of PFO patency, suggesting that some individuals are more likely to recruit their PFO in the face of even mild external resistance. Right-to-left bubble passage through the PFO occurs in conditions that are physiologically relevant to divers. Transthoracic echocardiography with mild external breathing resistance may be a tool to identify divers that are at risk of PFO-related decompression illness.

Echocardiography

Humans

Male

Foramen Ovale - diagnostic imaging

Young Adult

Esophagus - physiopathology

Inhalation - physiology

Foramen Ovale - physiopathology

Foramen Ovale, Patent - physiopathology

Embolism, Air - physiopathology

Exhalation - physiology

Foramen Ovale, Patent - diagnosis

Adolescent

Airway Resistance - physiology

Adult

Female

Foramen Ovale, Patent - complications

Embolism, Air - etiology

Embolism, Air - diagnostic imaging

Details

Title: Subtitle: Inspiratory and expiratory resistance cause right-to-left bubble passage through the foramen ovale
Creators: Kayla L Moses - Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
McKayla Seymour - Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
Arij Beshish - John Rankin Laboratory of Pulmonary Medicine, Department of Pediatrics, Critical Care Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Kim R Baker - Adult Echocardiography Laboratory, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
David F Pegelow - John Rankin Laboratory of Pulmonary Medicine, Department of Pediatrics, Critical Care Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Luke J Lamers - Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Marlowe W Eldridge - Department of Biomedical Engineering, University of Wisconsin-Madison, Iowa City, Iowa
Melissa L Bates - Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: Physiological reports, Vol.6(12), pp.e13719-n/a
DOI: 10.14814/phy2.13719
PMID: 29952137
PMCID: PMC6021277
NLM abbreviation: Physiol Rep
eISSN: 2051-817X
Publisher: United States
Grant note: R01 HL086897 / NHLBI NIH HHS
Language: English
Date published: 06/2018
Academic Unit: Stead Family Department of Pediatrics; Health, Sport, and Human Physiology ; Internal Medicine
Record Identifier: 9984002342802771

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