Four-Dimensional Flow Magnetic Resonance Imaging Features of a Platypnea-Orthodeoxia Syndrome Caused by a Patent Foramen Ovale

Sitbon, Samuel; Ou, Phalla; Nguyen, Chau; Ehmer, Carsten; Garbarz, Eric; Brochet, Éric; Fuchs, Adeline; Aubry, P; Abtan, Jérémie

doi:10.1161/circimaging.122.014722

Cited by 2 publications

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“…However, the PFO patients experienced very uncommon chronic hypoxemia while in the right lateral decubitus posture. As far as we are aware, previous cases were identified and managed using imaging and clinical signs of upright hypoxia [3]. A considerable preoperative diagnostic hurdle is posed by extended bed rest.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Hypoxemia in the Right Lateral Decubitus Position: A Case Report

Wu,

2024

IJACM

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Platypnea-Orthodeoxia syndrome (POS), an exceptionally uncommon condition, is characterized by decreased oxygen saturation in an upright posture with corresponding improvement in the supine position. Recently, an 85-year-old female patient presented for surgery due to a left femoral neck fracture. Following successful tracheal intubation and anesthesia induction, the ventilator indicated an airway pressure of 15mmHg. While in the right lateral decubitus position, the patient developed hypoxia despite normal arterial blood pressure and symmetrical breath sounds. Attempts to alleviate the hypoxia through pure oxygen ventilation, tympanic lung ventilation, and high-frequency ventilation were unsuccessful. Subsequently, there was a notable decrease in both blood pressure and heart rate, prompting an immediate halt to the surgery and repositioning the patient to the supine position. This resulted in the normalization of the patient's heart rate, oxygen saturation, and blood pressure. To investigate the etiology, a TEE probe was inserted, revealing the presence of a patent foramen ovale (PFO) and a significant right-to-left shunt while the patient was in the lateral position. The procedure was performed in a specific right lateral decubitus position. This case may represent a unique manifestation of POS syndrome, expanding the differential diagnosis for intraoperative position-related hypoxemia. Given the severe hypoxemia observed with intraoperative positional changes, a strong suspicion of POS syndrome is warranted.

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Section: Introductionmentioning

confidence: 99%