Less recognized conditions associated with PFO: Decompression illness, carcinoid heart disease, coronary spasm

A patent foramen ovale (PFO) increases the risk of developing serious phenotypes of decompression illness (DCI) in divers. Since the incidence of DCI is very low, routine screening of recreational scuba divers for PFO is not recommended. However, screening should be considered on a case-by-case basis and if present, consideration should be given to PFO closure if diving cessation or conservative diving are not options. The prevalence of PFO is higher in patients with carcinoid heart disease as compared to the general population. Most patients with left-sided carcinoid heart disease have a PFO which may indicate a causal relationship. There is limited evidence showing that PFO closure may improve symptoms in patients with carcinoid heart disease and advanced New York Heart Association functional class. The data on the relation of PFO to coronary spasm are limited. Some reports support the theory that PFO acts as a pathway for a chemical substrate that induces coronary vasospasm in patients with or without carcinoid syndrome or following foam sclerotherapy.