European Journal of Applied Physiology

, Volume 97, Issue 4, pp 478–485 | Cite as

A single open sea air dive increases pulmonary artery pressure and reduces right ventricular function in professional divers

  • Željko DujićEmail author
  • Ante Obad
  • Ivan Palada
  • Zoran Valic
  • Alf O. Brubakk
Original Article


After decompression from dives, bubbles are frequently observed in the right ventricular outflow tract and may lead to vascular damage, pulmonary arterial hypertension and right ventricular overload. No data exist on the effect of open sea diving on the pulmonary artery pressure (PAP). Eight professional divers performed an open sea air dive to 30 msw. Before and postdive a Doppler echocardiographic study was undertaken. Systolic pulmonary artery pressure (SPAP) was estimated from measurement of peak flow velocity of the tricuspid regurgitant jet; the ratio between pulmonary artery acceleration times (AccT) and right ventricular ejection time (RVET) was used as an estimate of the mean PAP. No evidence of either patent foramen ovale or intra-pulmonary shunt was found in any subject postdive after performing a Valsalva maneuver. SPAP increased from 25 ± 3 to 33 ± 2 mmHg and AccT/RVET ratio decreased from 0.44 ± 0.04 to 0.3 ± 0.02 20 min after the dive, respectively. Pulmonary vascular resistance increased from 1.2 ± 0.1 to 1.4 ± 0.1 Woods Units. Postdive right ventricle end-diastolic and end-systolic volumes were increased for about 19% (P = 0.001) and 33% (P = 0.001) and right ejection fraction decreased about for 6% (P = 0.001). Cardiac output decreased from 4.8 ± 0.9 (l min−1) to 4.0 ± 0.6 at 40 min postdive due to decreases in heart rate and stroke volume. This study shows that a single open sea dive may be associated with right heart overload due to increased pressure in the pulmonary artery.


Diving Pulmonary artery pressure Professional Cardiac output Gas bubbles 



This study was supported by the Croatian Ministry of Science, Education and Sports, Grant No. 216006 and by the Norwegian Petroleum Dierctorate, Norsk Hydro, Esso Norge and Statoil under the ‘Dive contingency contract no 4600002328’ with Norwegian Underwater Intervention. Authors would like to thank Aleksandra Mišak for the editing of the manuscript.


  1. Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA, Lester SJ (2003) A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol 41:1021–1027PubMedCrossRefGoogle Scholar
  2. Arborelius M Jr, Ballidin UI, Lilja B, Lundgren CE (1972) Hemodynamic changes in man during immersion with the head above water. Aerosp Med 43:592–598PubMedGoogle Scholar
  3. Balestra C, Germonpre P, Marroni A (1998) Intrathoracic pressure changes after Valsalva strain and other maneuvers: implications for divers with patent foramen ovale. Undersea Hyperb Med 25:171–174PubMedGoogle Scholar
  4. Behnke AR (1951) Decompression sickness following exposure to high pressures. In: Fulton JF (ed) Decompression sickness. Saunders, Philadelphia, pp 53–89Google Scholar
  5. Bove AA, Hallenbeck JM, Elliott DH (1974) Circulatory responses to venous air embolism and decompression sickness in dogs. Undersea Biomed Res 1:207–220PubMedGoogle Scholar
  6. Brubakk AO, Duplančić D, Valic Z, Palada I, Obad A, Baković D, Wisloff U, Dujić Ž (2005) A single air dive reduces arterial endothelial function in man. J Physiol 566:901–906PubMedCrossRefGoogle Scholar
  7. Butler BD, Conkin J, Luehr S (1989) Pulmonary hemodynamics, extravascular lung water and residual gas bubbles following low dose venous gas emboli. Aviat Space Environ Med 60:1178–1182PubMedGoogle Scholar
  8. Butler BD, Robinson R, Little T, Chelly JE, Doursout MF (1996) Cardiopulmonary changes with moderate decompression in rats. Undersea Hyperb Med 23:83–89PubMedGoogle Scholar
  9. Campana C, Pasotti M, Monti L, Revera M, Serio A, Nespoli L, Magrini G, Scelsi L, Ghio S, Tavazzi L (2004) The evaluation of right ventricular performance in different clinical models of heart failure. Eur Heart J 6: F61–F67CrossRefGoogle Scholar
  10. Diesel DD, Ryles MT, Pilmanis AA, Balldin UI (2002) Non-invasive measurement of pulmonary artery pressure in humans with simulated altitude-induced venous gas emboli. Aviat Space Environ Med 73:128–133PubMedGoogle Scholar
  11. Douglas PS, Berman GO, O’Toole ML, Hiller WD, Reicher N (1989) Prevalence of multivalvular regurgitation in atheletes. Am J Cardiol 64:209–212PubMedCrossRefGoogle Scholar
  12. Dujić Ž, Baković D, Marinović-Terzić I, Eterović D (2005a) Acute effects of single open-sea air dive and post-dive posture on cardiac output and pulmonary gas exchange in recreational divers. Br J Sports Med 39: e24CrossRefGoogle Scholar
  13. Dujić Ž, Palada I, Obad A, Duplančić D, Baković D, Valic Z (2005b) Exercise during three minute decompression stop reduces postdive venous gas bubbles in the field diving. Med Sci Sports Exerc 37:1319–1323CrossRefGoogle Scholar
  14. Dujić Ž, Palada I, Obad A, Duplančić D, Brubakk AO, Valic Z (2005c) Exercise-induced intrapulmonary shunting of venous gas emboli does not occur after open sea diving. J Appl Physiol 99:944–949CrossRefGoogle Scholar
  15. Eftedal O, Brubakk AO (1997) Agreement between trained and untrained observers in grading intravascular bubble signals in ultrasonic images. Undersea Hyperb Med 24:293–299PubMedGoogle Scholar
  16. Eldridge MW, Dempsey JA, Havenkamp HC, Lovering AT, Hokanson JS (2004) Exercise-induced intrapulmonary arteriovenous shunting in healthy humans. J Appl Physiol 97:797–805PubMedCrossRefGoogle Scholar
  17. Flook V (1997) The effect of exercise on decompression bubbles. A theoretical study. In: Mekjavic IB, Tipton MJ, Eiken O (eds) Proceedings of the XXIII annual scientific meeting of the European Underwater and Baromedical Societ. Bled, Slovenia, pp 55–61Google Scholar
  18. Kitabatake A, Inous A, Asao M, Masuyama T, Tanoucji J, Morita T, Mishima M, Uematsu M, Shizaku T, Hori M, Abe H (1983) Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation 68:302–309PubMedGoogle Scholar
  19. Kerut EK, Norfleet WT, Plotnick GD, Giles TD (2001) Patent foramen ovale: a review of associated conditions and the impact of physiological size. J Am Coll Cardiol 38:613–623PubMedCrossRefGoogle Scholar
  20. Landmesser U, Drexler H (2005) The clinical significance of endothelial dysfunction. Curr Opin Cardiol 20:547–551PubMedCrossRefGoogle Scholar
  21. Malik AB (1983) Pulmonary microembolization. Physiol Rev 63:1114–1207PubMedGoogle Scholar
  22. Marabotti C, Chiesa F, Scalzini A, Antonelli F, Lari R, Franchini C, Data PG (1999) Cardiac and humoral changes induced by recreational scuba diving. Undersea Hyperb Med 26:151–158PubMedGoogle Scholar
  23. Meyer K, Bucking J (2004) Exercise in heart failure: should aqua therapy and swimming be allowed? Med Sci Sports Exerc 36:2017–2023PubMedCrossRefGoogle Scholar
  24. Moon RE, Camporesi EM, Kisslo JA (1989) Patent foramen ovale and decompression sickness in divers. Lancet 1:513–514PubMedCrossRefGoogle Scholar
  25. Nishi RY (1990) Doppler evaluation of decompression tables. In: Lin YC, Shida KK (eds) Man in the sea. University of Hawaii Press, Honolulu, pp 297–316Google Scholar
  26. Nishi R, Brubakk AO, Eftedal O (2003) Bubble detection. In: Brubakk AO, Neumann TS (eds) Bennet and Elliot’s physiology and medicine of diving, 5th, ed W.B. Saunders, London, pp 501–529Google Scholar
  27. Nossum V, Brubakk AO (1999) Endothelial damage by bubbles in the pulmonary artery of the pig. Undersea Hyperb Med 26:1–8PubMedGoogle Scholar
  28. Nossum V, Hjelde A, Brubakk AO (2002) Small amounts of venous gas embolism cause delayed impairment of endothelial function and increase polymorphonuclear neutrophil infiltration. Eur J Appl Physiol 86:209–214PubMedCrossRefGoogle Scholar
  29. Pons M, Blickenstorfer D, Oechslin E, Hold G, Greminger P, Franzeck UK, Russi EW (1995) Pulmonary oedema in healthy persons during scuba-diving and swimming. Eur Respir J 8:762–767PubMedGoogle Scholar
  30. Risch WD, Koubenec HJ, Beckmann U, Lange S, Gauer OH (1978) The effect of graded immersion on heart volume, central venous pressure, pulmonary blood distribution, and heart rate in man. Pflugers Arch 374:115–118PubMedCrossRefGoogle Scholar
  31. Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ (1999) Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 83:897–902PubMedCrossRefGoogle Scholar
  32. US Navy diving manual (1996) Direction of Commander, Naval Sea System Command vol I (air diving)Google Scholar
  33. Valic Z, Duplančić D, Baković D, Ivančev V, Eterović D, Wisløff U, Brubakk AO, Dujić Ž (2005) Diving-induced venous gas emboli do not change pulmonary artery pressure. Int J Sports Med 26:626–631PubMedCrossRefGoogle Scholar
  34. Vik A, Brubakk AO, Hennessy TR, Jenssen BM, Ekker M, Slordahl SA (1990) Venous air embolism in swine: transport of gas bubbles through the pulmonary circulation. J Appl Physiol 69:237–244PubMedGoogle Scholar
  35. Vik A, Jensen BM, Eftedal O, Brubakk AO (1993) Relationship between venous bubbles and hemodynamic responses after decompression in pigs. Undersea Hyperb Med 20:233–248PubMedGoogle Scholar
  36. Yock PG, Popp RL (1984) Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 70:657–662PubMedGoogle Scholar
  37. Wilmshurst PT, Byrne JC, Webb-Peploe MM (1989) Relation between interatrial shunts and decompression sickness in divers. Lancet 2:1302–1306PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Željko Dujić
    • 1
    Email author
  • Ante Obad
    • 1
  • Ivan Palada
    • 1
  • Zoran Valic
    • 1
  • Alf O. Brubakk
    • 2
  1. 1.Department of PhysiologyUniversity of Split School of MedicineSplitCroatia
  2. 2.Department of Circulation and Medical ImagingNorwegian University of Science and TechnologyTrondheimNorway

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