Platypnea-orthodeoxia Syndrome Caused by a Latent Atrial Septal Defect

Takiguchi, Hiroto; Niimi, Kyoko; Aoki, Takuya; Ogiya, Rin; Ohno, Yohei; Nakazawa, Gaku; Ikari, Yuji; Abe, Tadashi; Asano, Koichiro

doi:10.2169/internalmedicine.52.0578

Cited by 9 publications

(4 citation statements)

References 10 publications

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“…By 2012, only 188 patients had been described with this syndrome, 1 making the diagnosis challenging and time-consuming. Although the pathophysiology of this entity remains somewhat uncertain, 2 there are basically three recognized etiologies: cardiac conditions with intracardiac shunting, pulmonary diseases with ventilation/perfusion mismatch and hepatic entities with pulmonary arteriovenous shunts. 1,3 Among these potential causes, cardiac conditions are the most frequently associated with this syndrome, 4 with patent foramen ovale (PFO) being the most common cause of intracardiac shunting, followed by atrial septal defects and atrial septal aneurysms.…”

Section: Introductionmentioning

confidence: 99%

Platypnea-Orthodeoxia Syndrome After Complicated Cholecystectomy: An Unsuspected Diagnosis

2017

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RESUMODoente do sexo feminino, 65 anos de idade, sem antecedentes pessoais relevantes, apresentou no pós-operatório de uma colecistectomia complicada diversos episódios de dessaturação arterial. Suspeitou-se repetidamente de tromboembolismo pulmonar, no entanto as diversas angio-tomografias computorizadas obtidas nunca revelaram a presença de trombos no leito vascular pulmonar. Atendendo a que os episódios de dessaturação eram maioritariamente despoletados por alterações posturais, foi levantada a hipótese de se tratar de uma síndrome de platipneia-ortodeoxia. Foi realizado ecocardiograma transtorácico, que revelou um foramen oval patente; o ecocardiograma transesofágico confirmou a presença de um shunt direito-esquerdo significativo, exacerbado pela manobra de Valsalva. O defeito foi reparado através de uma técnica transcatéter, com resolução completa do quadro clínico. Palavras-chave: Colecistectomia; Dispneia; Forame Oval Patente; Hipoxia; Síndrome ABSTRACT A 65-year-old woman with no significant prior medical history presented, in the postoperative course of a complicated cholecystectomy, several episodes of arterial desaturation. Pulmonary embolism was repeatedly suspected, but there was no evidence of pulmonary thrombus on the chest computed tomography angiographies obtained. As these episodes were mainly induced by postural changes, a platypnea-orthodeoxia syndrome was suspected. A transthoracic echocardiogram was performed and revealed a patent foramen ovale. A transesophageal echocardiography confirmed the presence of a significant right-to-left shunt exacerbated by the Valsalva manouver. The defect was repaired using a percutaneous transcatheter technique with complete resolution of the condition.

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Section: Introductionmentioning

confidence: 99%

Platypnea-Orthodeoxia Syndrome After Complicated Cholecystectomy: An Unsuspected Diagnosis

2017

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“…The most frequent cause is interatrial shunting via an AIC or PFO. When right atrial pressure is higher than left atrial pressure under conditions such as pericardial disease, PE or right heart infarction, a right-to-left shunt across the defect occurs [10] [11]. However, when there are anatomical and functional components that direct venous blood flow to the AIC or PFO, as in patients with a prominent Eustachian valve or aortic elongation or dilatation, a right-to-left shunt can occur even in the absence of elevated right atrial pressure [12].…”

Section: Discussionmentioning

confidence: 99%

Platypnea-Orthodeoxia Syndrome in an Elderly Patient Treated with Percutaneous Patent Foramen Ovale Closure: Report of a Case and Review of the Literature

Diouldé,

Mariama,

Madiou

et al. 2023

WJCD

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Introduction: Platypnea-Orthodeoxia syndrome is characterized by dyspnea and hypoxia in the upright position, usually improving in the supine position. Two components are required: an interatrial or intrapulmonary shunt, and a functional component. Diagnosis is made by contrast ultrasonography. We report a case of Platypnea-Orthodeoxia syndrome revealed by positional dyspnea in an 87-year-old patient. The aim of this study is to describe the clinical, therapeutic and evolutionary profile of this syndrome. Case Presentation: This is an 87-year-old patient with a history of pulmonary embolism (PE) and stroke. He was seen for dyspnea and desaturation in orthostatism, revealing a patent foramen ovale (PFO). Progression was favorable after closure of the PFO. Conclusion: Platypnea-Orthodeoxia syndrome may be presented as simple exertional dyspnea. The clinician should check for improvement in symptoms and/or oxygenation during decubitus. Definitive treatment consists of percutaneous closure of the shunt.

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“… 4 The most common cause is interatrial shunting through an ASD or PFO. 5 , 6 When the right atrial pressure is higher than the left atrial pressure in conditions such as pericardial disease, pulmonary embolism, or right heart infarction, right-to-left shunting through the defect occurs. However, when there are anatomical and functional components that direct venous blood flow toward the ASD/PFO, as in patients with a prominent Eustachian valve 7 or aortic elongation or dilatation, 8 right-to-left shunting can occur even in the absence of elevated right atrial pressure.…”

Section: Discussionmentioning

confidence: 99%

Posture-Related Change in Intracardiac Blood Flow Detected by Transesophageal Echocardiography in Platypnea-Orthodeoxia Syndrome

Mima

Sakamoto

Miyake

et al. 2022

CASE

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Platypnea-orthodeoxia Syndrome Caused by a Latent Atrial Septal Defect

Cited by 9 publications

References 10 publications

Platypnea-Orthodeoxia Syndrome After Complicated Cholecystectomy: An Unsuspected Diagnosis

Platypnea-Orthodeoxia Syndrome After Complicated Cholecystectomy: An Unsuspected Diagnosis

Platypnea-Orthodeoxia Syndrome in an Elderly Patient Treated with Percutaneous Patent Foramen Ovale Closure: Report of a Case and Review of the Literature

Posture-Related Change in Intracardiac Blood Flow Detected by Transesophageal Echocardiography in Platypnea-Orthodeoxia Syndrome

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