• Timothy P Beck, Nicholas Tsipis, Joseph A Kisslo, José D Rivera, Alicia C Armour, and Richard E Moon.
• Duke University School of Medicine, Durham, NC; Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC.
• Chest. 2022 Mar 1; 161 (3): e137-e143.

AbstractImmersion pulmonary edema, more commonly referred to as swimming-induced pulmonary edema (SIPE), is a well-documented condition believed to be a result of immersion physiologic condition that is characterized by a peripheral-to-central redistribution of blood volume. It disproportionally affects young, healthy athletes with no clinically overt cardiovascular or pulmonary conditions. We present four cases of healthy athletes with previously documented SIPE, who participated in Institutional Review Board-approved clinical studies that examined the pathophysiologic condition and prevention of SIPE. During standard recumbent echocardiography, trivial mitral regurgitation was observed in all four individuals. Acute exacerbation of their mitral regurgitation was observed during immersion with both immersed resting and immersed exercise echocardiography, contributing to the development of SIPE. These observations demonstrate that the occurrence of subclinical or trivial mitral valve regurgitation during dry rest is a novel risk factor for SIPE. We propose the use of immersion echocardiography as a useful investigative tool for otherwise healthy individuals with SIPE and no previously explainable cause.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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