ArticleJACC. Case reports2026
DCI With Severe Portal Venous Gas Embolism After Cave Diving in a Diver With a PFO.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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3 authors.
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Abstract
backgroundCave diving involves prolonged bottom times and limited ascent routes, markedly increasing inert gas load and the risk of decompression illness (DCI). The presence of a patent foramen ovale (PFO) further elevates this risk. CASE SUMMARY: A dive trainer developed DCI with severe portal venous air embolism after a 2.5-h cave dive. Symptoms included >20 min of mental confusion, skin rashes, and mild abdominal discomfort. Hyperbaric therapy improved his condition. Transesophageal echocardiography revealed a grade III, high-risk PFO. Following shared decision-making, percutaneous PFO closure was successfully performed. After 4 months of abstinence, the patient completed 150 subsequent dives without the recurrence of DCI. We continue to encourage adherence to all available measures to minimize nitrogen load. DISCUSSION: Venous bubbles, including portal venous air embolism, cannot be reliably mitigated solely by PFO closure. TAKE-HOME MESSAGE: Extreme nitrogen loading during cave diving with a high-risk PFO substantially increases the likelihood of DCI, underscoring the importance of nitrogen-minimizing strategies and the need for targeted PFO screening in divers with repeated high-exposure profiles.
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