In patients with coronary heart disease, the introduction of antianginal medications, when including beta-blockers, appears to have a favorable effect on the deleterious prognostic effect of exercise ischemia.

The number of recreational scuba divers is steadily increasing. In its latest recommendations, the French Federation of Undersea Studies and Sports listed congenital heart disease as a formal and final contraindication to scuba diving. On the other hand, with the progress made in their management, the prognosis and quality of life of patients with congenital heart diseases have improved considerably, enabling them to engage in physical and sports endeavours, which are known to confer general health and psychological benefits. As a consequence, the ability of these patients to dive has become a regular and recurrent issue. We review the various types of scuba diving, the physical performance required for its practice, its effects on cardiovascular function and the elements that need to be considered before recommending whether it can be practiced safely at various levels of difficulty. Because of the diversity and broad heterogeneity of congenital heart diseases, a detailed evaluation of each patient's performance based on clinical criteria common to all congenital heart diseases is recommended.

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International audienceThe number of people wishing to practice leisure scuba diving is constantly increasing. Currently, Congenital Heart Diseases (CHD) were so far considered contra-indications in the list edited by the Medical and Prevention Commission of the French Underwater Federation. However, due to the progress in their care, the number of living patients with CHD increase. Their quality of life has been also improved, allowing them to practice physical and sports activities the beneficial effect of which has been proven. Thus the question of fitness to dive is put forward. We thought necessary to reconsider the problem in order to define parameters to help in the decision to allow or not diving for these patients. Because of their diversity and of an important heterogeneousness even within a defined group of CHD, we tried to avoid drafting a boring catalog. Thus we propose for every patient a practical and precise evaluation of its capacity from clinical criteria and further common evaluation obtained during usual follow-up of these CHD. The practice of the scuba diving could be authorized according to the clinical and rhythmic status, echocardiographic parameters and physical fitness assessed by exercise testing with gas exchange analysi