Can patent foramen ovale affect rehabilitation? The uncommon association of platypnea-orthodeoxia syndrome and stroke

Abstract

Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea and deoxygenation induced by a change to a sitting or standing from a recumbent position. It is the result of posturally accentuated intracardiac or pulmonary right-to-left shunt leading to arterial oxygen desaturation. Only few cases of platypnea-orthodeoxia syndrome are reported in the literature and the association between stroke and platypnea-orthodeoxia syndrome with evidence of patent foramen ovale is extremely rare. We describe the case of a 67-year-old female admitted to our Rehabilitation Unit for disabling basilar stroke due to paradoxical embolism from patent foramen ovale that during the first days of rehabilitation showed signs and symptoms of platypnea-orthodeoxia syndrome. To remove a life-threatening condition for the patient and in order to develop the normal rehabilitation project, that was stopped by the platypnea-orthodeoxia syndrome, the patient fastly underwent to percutaneous closure of patent foramen ovale. The stabilization of oxygen arterial saturation with postural changes and the disappearance of symptoms of POS allowed to develop the rehabilitation project with progressive neurological improvement.

TIA Caused by Contrast Echocardiography in Patient with Platypnea–Orthodeoxia

“…Only few cases of POS and stroke were reported in literature, and the association between stroke and POS with evidence of PFO is extremely rare. 2,3 To our knowledge, no previous case of TIA/stroke during contrast echocardiography in patients with POS has been published so far. In our patient, the most likely cause of TIA was injection of agitated saline solution during the search for interatrial communication in patient with POS.…”

“…Only few cases of POS and stroke were reported in literature; thus, the association between stroke and POS with evidence of PFO is extremely rare. 2,3 Ischemic cerebrovascular complications may occur in patients with cardiac shunt who undergo contrast echocardiography using agitated saline intravenous injection. 4 We present a patient with transitory ischemic attack (TIA) induced by contrast echocardiography during evaluation of POS.…”

Ischemic Stroke Due to Paradoxical Embolism in a Patient with Patent Foramen Ovale, Bilateral Distal Deep Vein Thrombosis and Platypnea-Orthodeoxia Syndrome: A Case Report

“…Cryptogenic stroke caused by paradoxical embolism and platypnea-orthodeoxia syndrome are both well described complications of PFO, but case reports of their coexistence in the same patient are few [12] [13] [14] [15]. Noticeably, all these previous reports underline the efficacy of PFO closure on relieving respiratory symptoms and preventing new cerebral ischemic events.…”

Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome

“…This was effective not only in HPS 13, but also in non‐HPS patients with orthodeoxia 24. Due to the increased risk of aspiration in Trendelenburg position, we recommend advance placement of a post‐pyloric feeding tube at the time of LT.…”