Assessing potential divers with a history of congenital heart disease

Area of Science:

• Cardiology
• Diving Medicine
• Sports Medicine

Background:

• Congenital heart disease (CHD) presents unique challenges for recreational diving.
• Assessing fitness to dive requires a comprehensive understanding of CHD, surgical history, and potential complications.

Purpose of the Study:

• To present a structured framework for evaluating the medical fitness of individuals with a history of CHD for diving.
• To identify key risk factors and necessary investigations for safe diving practices in this population.

Main Methods:

• Detailed cardiac history including surgical and interventional procedures.
• Assessment of intracardiac shunts, exercise capacity, and diving-specific risks (e.g., pulmonary edema, arrhythmia).
• Utilizing investigations such as echocardiography, exercise testing, MRI, CT scans, cardiopulmonary exercise testing, and ECG monitoring.

Main Results:

• The approach considers risks associated with surgical/catheter treatments, lung injury, and limitations of implanted devices like pacemakers.
• Case examples illustrate the application of the approach to specific CHD conditions (e.g., atrial septal defect, tetralogy of Fallot, bicuspid aortic valve, Fontan circulation).

Conclusions:

• The proposed framework provides a systematic method for cardiologists to assess diving fitness in patients with CHD.
• While not strictly evidence-based, it adapts existing diving medicine principles to this complex patient group, prioritizing individual assessment.