Transcatheter closure of patent foramen ovale using the Amplatzer septal occluder to prevent recurrence of neurological decompression illness in divers.
OBJECTIVE: Large flap valve patent foramens may cause paradoxical thromboembolism and neurological decompression illness in divers. The ability of a self expanding Nitinol wire mesh device (Amplatzer septal occluder) to produce complete closure of the patent foramen ovale was assessed. PATIENTS: Seven adults, aged 18-60 years, who had experienced neurological decompression illness related to diving. Six appeared to have a normal atrial septum on transthoracic echocardiography, while one was found to have an aneurysm of the interatrial septum. METHODS: Right atrial angiography was performed to delineate the morphology of the right to left shunt. The defects were sized bidirectionally with a precalibrated balloon filled with dilute contrast. The largest balloon diameter that could be repeatedly passed across the septum was used to select the occlusion device diameter. Devices were introduced through 7 F long sheaths. All patients underwent transthoracic contrast echocardiography one month after the implant. RESULTS: Device placement was successful in all patients. Device sizes ranged from 9-14 mm. The patient with an aneurysm of the interatrial septum had three defects, which were closed with two devices. Right atrial angiography showed complete immediate closure in all patients. Median (range) fluoroscopy time was 13.7 (6-35) minutes. Follow up contrast echocardiography showed no right to left shunting in six of seven patients and the passage of a few bubbles in one patient. All patients have been allowed to return to diving. CONCLUSION: The Amplatzer septal occluder can close the large flap valve patent foramen ovale in divers who have experienced neurological decompression illness. Interatrial septal aneurysms with multiple defects may require more than one device. (+info)
Experiment of nitrox saturation diving with trimix excursion.
Depth limitations to diving operation with air as the breathing gas are well known: air density, oxygen toxicity, nitrogen narcosis and requirement for decompression. The main objectives of our experiment were to assess the decompression, counterdiffusion and performance aspect of helium-nitrogen-oxygen excursions from nitrox saturation. The experiment was carried out in a wet diving stimulator with "igloo" attached to a 2-lock living chamber. Four subjects of two teams of 2 divers were saturated at 25 msw simulated depth in a nitrogen oxygen chamber environment for 8 days, during which period they performed 32 divers-excursions to 60 or 80 msw pressure. Excursion gas mix was trimix of 14.6% oxygen, 50% helium and 35.4% nitrogen, which gave a bottom oxygen partial pressure of 1.0 bars at 60 msw and 1.3 at 80 msw. Excursions were for 70 min at 60 msw with three 10-min work periods and 40 min at 80 msw with two 10-min work periods. Work was on a bicycle ergometer at a moderate level. We calculated the excursion decompression with M-Values based on methods of Hamilton (Hamilton et al., 1990). Staged decompression took 70 min for the 60 msw excursion and 98 min for 80 msw, with stops beginning at 34 or 43 msw respectively. After the second dive day bubbles were heard mainly in one diver but in three divers overall, to Spencer Grade III some times. No symptoms were reported. Saturation decompression using the Repex procedures began at 40 msw and was uneventful: Grade II and sometimes III bubbles persisted in 2 of the four divers until 24 hr after surfacing. We conclude that excursions with mixture rich in helium can be performed effectively to as deep as 80 msw using these procedures. (+info)
Development of diving capacity in emperor penguins.
To compare the diving capacities of juvenile and adult emperor penguins Aptenodytes forsteri, and to determine the physiological variables underlying the diving ability of juveniles, we monitored diving activity in juvenile penguins fitted with satellite-linked time/depth recorders and examined developmental changes in body mass (Mb), hemoglobin concentration, myoglobin (Mb) content and muscle citrate synthase and lactate dehydrogenase activities. Diving depth, diving duration and time-at-depth histograms were obtained from two fledged juveniles during the first 2.5 months after their depature from the Cape Washingon colony in the Ross Sea, Antarctica. During this period, values of all three diving variables increased progressively. After 8-10 weeks at sea, 24-41 % of transmitted maximum diving depths were between 80 and 200 m. Although most dives lasted less than 2 min during the 2 month period, 8-25 % of transmitted dives in the last 2 weeks lasted 2-4 min. These values are lower than those previously recorded in adults during foraging trips. Of the physiological variables examined during chick and juvenile development, only Mb and Mb content did not approach adult values. In both near-fledge chicks and juveniles, Mb was 50-60 % of adult values and Mb content was 24-31 % of adult values. This suggests that the increase in diving capacity of juveniles at sea will be most dependent on changes in these factors. (+info)
Heart rate and behavior of fur seals: implications for measurement of field energetics.
Archival data loggers were used to collect information about depth, swimming speed, and heart rate in 23 free-ranging antarctic fur seals. Deployments averaged 9.6 +/- 5.6 days (SD) and totaled 191 days of recording. Heart rate averaged 108.7 +/- 17.7 beats/min (SD) but varied from 83 to 145 beats/min among animals. Morphometrics explained most variations in heart rate among animals. These interacted with diving activity and swimming speed to produce a complex relationship between heart rate and activity patterns. Heart rate was also correlated with behavior over time lags of several hours. There was significant (P < 0.05) variation among animals in the degree of diving bradycardia. On average, heart rate declined from 100-130 beats/min before the dive to 70-100 beats/min during submersion. On the basis of the relationship between heart rate and rate of oxygen consumption, the overall metabolic rate was 5.46 +/- 1.61 W/kg (SD). Energy expenditure appears to be allocated to different activities within the metabolic scope of individual animals. This highlights the possibility that some activities can be mutually exclusive of one another. (+info)
Convective oxygen transport and tissue oxygen consumption in Weddell seals during aerobic dives.
Unlike their terrestrial counterparts, marine mammals stop breathing and reduce their convective oxygen transport while performing activities (e.g. foraging, courtship, aggressive interactions, predator avoidance and migration) that require sustained power output during submergence. Since most voluntary dives are believed to remain aerobic, the goal of this study was to examine the potential importance of the dive response in optimizing the use of blood and muscle oxygen stores during dives involving different levels of muscular exertion. To accomplish this, we designed a numerical model based on Fick's principle that integrated cardiac output (Vb), regional blood flow, convective oxygen transport (Q(O2)), muscle oxymyoglobin desaturation and regional rates of oxygen consumption (VO2). The model quantified how the optimal matching or mismatching of QO2 to VO2 affected the aerobic dive limit (ADL). We chose an adult Weddell seal Leptonycotes weddellii on which to base our model because of available data on the diving physiology and metabolism of this species. The results show that the use of blood and muscle oxygen stores must be completed at the same time to maximize the ADL for each level of VO2. This is achieved by adjusting Vb (range 19-94 % of resting levels) and muscle QO2 according to the rate of muscle oxygen consumption (VMO2). At higher values of VMO2, Vb and muscle perfusion must increase to maintain an appropriate QO2/VO2 ratio so that available blood and muscle oxygen stores are depleted at the same time. Although the dive response does not sequester blood oxygen exclusively for brain and heart metabolism during aerobic dives, as it does during forced submersion, a reduction in Vb and muscle perfusion below resting levels is necessary to maximize the ADL over the range of diving VO2 (approximately 2-9 ml O2 min-1 kg-1). Despite the reduction in Vb, convective oxygen transport is adequate to maintain aerobic metabolism and normal function in the splanchnic organs, kidneys and other peripheral tissues. As a result, physiological homeostasis is maintained throughout the dive. The model shows that the cardiovascular adjustments known as the dive response enable the diving seal to balance the conflicting metabolic demands of (1) optimizing the distribution and use of blood and muscle oxygen stores to maximize the ADL over the normal range of diving VO2 and (2) ensuring that active muscle receives adequate oxygen as VMO2 increases. (+info)
Diving and the risk of barotrauma.
STUDY OBJECTIVES: Pulmonary barotrauma (PBT) of ascent is a feared complication in compressed air diving. Although certain respiratory conditions are thought to increase the risk of suffering PBT and thus should preclude diving, in most cases of PBT, risk factors are described as not being present. The purpose of our study was to evaluate factors that possibly cause PBT. DESIGN: We analyzed 15 consecutive cases of PBT with respect to dive factors, clinical and radiologic features, and lung function. They were compared with 15 cases of decompression sickness without PBT, which appeared in the same period. RESULTS: Clinical features of PBT were arterial gas embolism (n = 13), mediastinal emphysema (n = 1), and pneumothorax (n = 1). CT of the chest (performed in 12 cases) revealed subpleural emphysematous blebs in 5 cases that were not detected in preinjury and postinjury chest radiographs. A comparison of predive lung function between groups showed significantly lower midexpiratory flow rates at 50% and 25% of vital capacity in PBT patients (p < 0.05 and p < 0.02, respectively). CONCLUSIONS: These results indicate that divers with preexisting small lung cysts and/or end-expiratory flow limitation may be at risk of PBT. (+info)
High aerobic capacities in the skeletal muscles of pinnipeds: adaptations to diving hypoxia.
The objective was to assess the aerobic capacity of skeletal muscles in pinnipeds. Samples of swimming and nonswimming muscles were collected from Steller sea lions (Eumetopias jubatus, n = 27), Northern fur seals (Callorhinus ursinus, n = 5), and harbor seals (Phoca vitulina, n = 37) by using a needle biopsy technique. Samples were either immediately fixed in 2% glutaraldehyde or frozen in liquid nitrogen. The volume density of mitochondria, myoglobin concentration, citrate synthase activity, and beta-hydroxyacyl-CoA dehydrogenase was determined for all samples. The swimming muscles of seals had an average total mitochondrial volume density per volume of fiber of 9.7%. The swimming muscles of sea lions and fur seals had average mitochondrial volume densities of 6.2 and 8.8%, respectively. These values were 1.7- to 2.0-fold greater than in the nonswimming muscles. Myoglobin concentration, citrate synthase activity, and beta-hydroxyacyl-CoA dehydrogenase were 1.1- to 2. 3-fold greater in the swimming vs. nonswimming muscles. The swimming muscles of pinnipeds appear to be adapted for aerobic lipid metabolism under the hypoxic conditions that occur during diving. (+info)
Functional and high-resolution computed tomographic studies of divers' lungs.
OBJECTIVES: Several cross-sectional studies have described a decrease in the expiratory flow rates of divers. The objective of this study was to determine whether the combined application of high-resolution computed tomography (HRCT) and lung function testing supports the reported development of small airway obstruction in divers. METHODS: Thirty-two navy divers, 27 commercial divers, and 48 referents matched for age and smoking history underwent pulmonary function testing and HRCT of the lungs supplemented by a limited number of expiratory scans. The commercial divers were older and dived longer than the navy divers. Multivariate regression analysis was used to assess the relevant correlations of age, height, pack-years of cigarette smoking, and indices of diving exposure with lung function parameters. RESULTS: The inspiratory vital capacity and forced vital capacity (FVC) were greater, while the FEV% [(100 x FEV10)FVC] and maximum expiratory flow (MEF) at 25% (MEF25) of the FVC were lower for the navy divers than for the referents. The lung volumes and expiratory airflow pattern did not differ between the commercial divers and the corresponding referents. The forced expiratory volume in 1 second (FEV10), FEV%, MEF75, and MEF25 correlated negatively with the years of diving experience. This association was independent of age, height, and pack-years of cigarette smoking. For the majority of the divers and referents the expiratory HRCT revealed minor lobular air trapping without any difference between the groups. The HRCT did not show relevant morphologic abnormalities of small or large airways. CONCLUSIONS: The data confirm that diving may affect pulmonary function. However, there is no radiologic evidence for the development of small airway disease in these 2 subgroups of divers. (+info)