VSD and fitness to dive
I have a 19 year old male patient who aspires to study marine biology. He has a small ventricular septal defect. He has had a recent echo, which "demonstrates a small mid muscular ventricular septal defect with a small left to right shunt. This defect does have some evidence of spontaneous closure with a cap of tissue on the right ventricular aspect but the defect itself measures only in teh order of 1-2mms. Pulkmonary artery pressures appear normal and the left ventricle is at the upper limits of normal with normal systolic function."
I would appreciate the opinions and advice of the diving medical community regardign his fitness to dive.
Small muscular VSD with normal PA pressure and normal cavity size and LV function is not likely to cause any major problems with exercsie capacity, arrhythmia risk or diving indiced pulmonary oedema. I usually do a bubble contrast echo with Valsalva to see if there is any potential for right to left shunt. Under normal conditions the LV pressure exceeds the RV pressure, but at certain phases of the cardiac cycle or under provocative conditions, it is possible to get a right to left shunt. Also some congenital heart disease may have an increased prevalence of PFO. If he aspires to work under water it would be worth doing a bubble test. In the UK we do this with transthoracic echo according to the Wilmshurst protocol. If this chap had a perimembranous VSD, the advice would be the same but to also check the aortic valve and if he had a VSD closure, it would be the same again plus a check for heart block.
Mark Turner, Consultant Cardiologist, Bristol Heart Institute, UK
EDIT: Duplicates removed: SPUMS Webmaster