Platypnea-orthodeoxia Syndrome in a Patient with an Atrial Septal Defect: The Diagnosis and Choice of Treatment

Kazawa, Shuichiro; Enomoto, Takashi; Suzuki, Naomasa; Koshikawa, Tomoyasu; Okubo, Yuka; Yoshii, Shinpei; Sato, Masahito; Okabe, Masaru; Yamashina, Akira; Aizawa, Yoshifusa

doi:10.2169/internalmedicine.56.7728

Cited by 8 publications

(11 citation statements)

References 14 publications

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“…Among cardiac causes, patent foramen ovale is the most frequent lesion and ASD ranks second [4]. TEE, the preferred diagnostic study to visualize cardiac defects or aneurysms, confirmed an ostium secundum ASD in this patient.…”

Section: Discussionmentioning

confidence: 59%

POJ Clinical Case Reports | Volume 1- Issue 1 – 2018

2018

POJ Clin Case Rep

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Platypnea orthodeoxia syndrome is an uncommon phenomenon characterized by dyspnea and arterial desaturation in an upright position improved with recumbency. It is due to an anatomical factor that allows for interatrial communication and a functional factor that promotes right to left shunting. Once identified, early intervention allows for rapid symptomatic improvement. This case highlights that among patients who present with positional hypoxia, POS should be considered as a possible etiology. Thorough evaluation is warranted to identify potentially reversible etiologies and guide management.

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Section: Discussionmentioning

confidence: 59%

POJ Clinical Case Reports | Volume 1- Issue 1 – 2018

2018

POJ Clin Case Rep

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Section: Discussionmentioning

confidence: 66%

“…Our findings reinforce the hypothesis that, due to their geometry and anatomic proximity, the aortic root dilation could increase ASM. This mechanism was already postulated in case reports of patients with platypnea-orthodeoxia syndrome (Kazawa et al, 2017). Aortic atherosclerosis and dilation are also associated with cardiovascular risk factors and vascular clinical events (Gardin et al, 2006).…”

Section: Discussionmentioning

confidence: 77%

Increased Mobility of the Atrial Septum in Aortic Root Dilation: An Observational Study on Transesophageal Echocardiography

et al. 2021

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Background: There is a growing interest in the relationship between atrial septal anatomy and cardioembolic stroke. Anecdotal reports suggest that the enlargement of the aortic root could interfere with atrial septal mobility (ASM). We sought to investigate the association between ASM and aortic root dilation.Methods and Findings: From all consecutive clinically requested transesophageal echocardiogram (TEE) studies performed during the study period in a single institution, we were able to review and evaluate the ASM and anteroposterior length, aortic root diameter, and the prevalence of atrial septal aneurysm (ASA) and of patent foramen ovale (PFO) in 336 studies. Additional variables, such as left ventricular ejection fraction, left atrial diameter, diastolic dysfunction, age, sex, weight, height, previous stroke, atrial fibrillation, and TEE indication, were extracted from patient medical records and echocardiographic clinical reports. In 336 patients, we found a mean ASM of 3.4 mm, ranging from 0 to 21 mm; 15% had ASA and 14% had PFO. There was a 1.0 mm increase in ASM for every 10-mm increase in aortic root diameter adjusted for age, sex, weight, height, ejection fraction, and left atrial size (B = 0.1; P = 0.04). Aortic diameter was not associated with a smaller septal length (B = 0.03; P = 0.7).Conclusion: An increased motion of the atrial septum can occur in association with aortic dilation. These findings deserve attention for the relevance of aortic root anatomy in future studies involving atrial septal characteristics and embolic stroke risk.

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“…Subsequently, right-to-left shunt must be confirmed. TEE is crucial for direct visualization of the shunt flow or structural abnormalities and has been used in some reported cases (4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

“…It is reportedly caused by right-to-left shunt, which is augmented by anatomical changes in the upright posture (2). A small number of cases of POS have been reported (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), and their pathogenesis is complex and not uniform.…”

Section: Introductionmentioning

confidence: 99%

Platypnea-orthodeoxia Syndrome Due to Right Ventricular Inflow Tract Obstruction Caused by an Elongated Ascending Aorta: Usefulness of Three-dimensional Cardiac Computed Tomography Imaging in the Sitting Position

et al. 2022

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An 84-year-old woman presented with dyspnea in the sitting position. Platypnea-orthodeoxia syndrome (POS) was suspected based on arterial desaturation when her posture changed from the supine to the sitting position. Transesophageal echocardiography showed right-to-left shunting enhancement through a patent foramen ovale (PFO) in the sitting position. Three-dimensional (3D) cardiac CT in the sitting position revealed that the elongated ascending aorta compressed the right ventricular inflow tract, resulting in restricted blood flow to the right ventricle and increased right-to-left shunting. This case highlights the role of 3D-CT in the sitting position in the management of POS.

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Platypnea-orthodeoxia Syndrome in a Patient with an Atrial Septal Defect: The Diagnosis and Choice of Treatment

Cited by 8 publications

References 14 publications

POJ Clinical Case Reports | Volume 1- Issue 1 – 2018

POJ Clinical Case Reports | Volume 1- Issue 1 – 2018

Increased Mobility of the Atrial Septum in Aortic Root Dilation: An Observational Study on Transesophageal Echocardiography

Platypnea-orthodeoxia Syndrome Due to Right Ventricular Inflow Tract Obstruction Caused by an Elongated Ascending Aorta: Usefulness of Three-dimensional Cardiac Computed Tomography Imaging in the Sitting Position

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