# Recurrent decompression sickness and late repermeabilization of patent foramen oval closure prosthesis: a diver’s dilemma—case report

## TL;DR

A diver experienced decompression sickness years after a PFO closure, showing the prosthesis may become permeable over time.

## Contribution

Reports a rare case of late repermeabilization of a PFO closure prosthesis in a diver.

## Key findings

- A diver had recurrent DCS 10 years after PFO closure with a STARFLEX® prosthesis.
- Diagnostic tests confirmed the prosthesis had become permeable again.
- The case raises concerns about the long-term effectiveness of PFO closure in divers.

## Abstract

Decompression sickness (DCS) is a well-known risk associated with scuba diving, particularly in people with right-to-left shunt, such as patent foramen oval (PFO). Herein, we present a unique case of late PFO permeabilization after closure.

A 26-year-old male diver was diagnosed with DCS following a dive at 36 m. He underwent PFO closure with a STARFLEX® prosthesis. Ten years later, the patient was presented with recurrent manifestations suggestive of DCS. The performed diagnostic work-up detects a permeabilization of the implanted prosthesis, and he was treated with a conservative approach.

This case highlights the challenges in the management of PFO in divers and raises concerns about the long-term efficiency of PFO closure and the impact of diving-related factors on prosthesis patency.