Genetic variation and patent foramen ovale: approaches to management through exercise and sports medicine.

Abstract The non-closure of foramen ovale has been held responsible for increased risk in several pathologies. The patent foramen ovale (PFO) is an abnormality of the interatrial septum, present in 20-30% of the general population. It has been associated with several causes of morbidity such as strokes, migraine, paradoxical embolism. In exercise and sports medicine, it is associated with extra risk of pathologies in all sports in particularly in high-altitude excursions and trekking or underwater activities (decompression sickness). To provide better recommendations for doctors managing patients with this pathology, we initially aimed to verify both risk factors and hereditary aspects. Initially, we tested these two hypotheses: Does the presence of a PFO in a patient increase the risk of a desaturation accident? Is the persistence of the foramen ovale inherited? To facilitate improved clinical decision making for physicians managing patients with patent foramen ovale (PFO), we developed decision trees based on common clinical scenarios. These tools are intended to help assess the suitability of individuals for participation in hyperbaric activities, whether recreational or professional. The decision trees also address the management of patients who have experienced saturation accidents and offer guidance to support their families. o Evaluate whether there are contraindications for patients considering hyperbaric activities, either for leisure or work purposes. o Provide case by case recommendations in which patients suffered from saturation accidents. o Offer support and information to the families of affected patients.