Platypnea-orthodeoxia syndrome in an elderly woman with a patent foramen ovale

Pierce, Cameron W.

doi:10.1016/s0828-282x(10)70372-x

Cited by 9 publications

(7 citation statements)

References 5 publications

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“…The exact cause of platypnea-orthodeoxia syndrome is not fully understood, possibly because patients do not present with pulmonary hypertension and right chamber pressure is normal. 1,2 Both anatomic and functional abnormalities must be present to cause platypnea-orthodeoxia syndrome. 3 The anatomic component refers to the presence of any structural defect which allows interatrial communication, including patent foramen ovale, atrial septal defect and fenestrated atrial septal aneurysm.…”

Section: Key Points Discussionmentioning

confidence: 99%

Cardiac platypnea-orthodeoxia syndrome in a 73-year-old woman

2015

CMAJ

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A 73-year-old woman was admitted because of progressive shortness of breath over the previous two weeks, which affected her daily activities. She had a history of congestive heart failure (New York Heart Association functional class II), hypertension and scoliosis. Her medications included acetylsalicylic acid, amiloride, hydrochlorothiazide, atenolol, rosuvastatin and spironolactone. She had no orthopnea or productive cough. On physical examination, her heart sounds were normal, without murmur. An electrocardiogram showed normal sinus rhythm.During the patient's stay in hospital, intermittent hypoxemia was noted when she was eating or sitting upright; hypoxemia improved when the patient was lying down. Oxygen saturation was found to step-down gradually, from 90% (when the patient was supine) to 78% (45° recline) to 69% (90° upright), before recovering to 87% (return to supine).A transthoracic echocardiogram showed a mildly dilated left atrium with a mildly dilated aortic root (3.95 cm). No valvular abnormalities, pericardial effusion or atrial septal aneurysm were seen. Bubbles were seen in the left atrium and ventricle within three cardiac cycles on bubble echocardiography (Figure 1 and Appendix 1, available at www.cmaj.ca/lookup/suppl/ doi:10.1503/cmaj.141525/-/DC1), suggesting intracardiac shunting. Computed tomography of the chest showed no evidence of lung parenchymal disease or pulmonary embolism; however, scoliosis and a tortuous, dilated aortic root were noted. Right heart catheterization confirmed normal pulmonary pressure (mean pulmonary arterial pressure 12 mm Hg; mean right atrial pressure 4 mm Hg) and a normal Qp/Qs ratio (0.46). Direct measurement of oxygen saturation during cardiac catheterization showed a step-down pattern: peripheral arterial saturation (SPo 2 ) in pulmonary capillary wedge position, left ventricle and aorta were 99.7%, 85.5% and 88.6%, respectively, which is compatible with the presence of intracardiac right-to-left shunt through a patent foramen ovale. We diagnosed platypneaorthodeoxia syndrome.The patient was scheduled for transfer to a tertiary care centre for further surgical intervention. Because her oxygen saturation fluctuated between 80%-90% in the supine position, we questioned whether she would be able to tolerate the three-hour journey. Considering the pathophysiology of platypnea-orthodeoxia syndrome, we attempted to increase left ventricular enddiastolic pressure using a vasopressor to improve right-to-left shunting. We initially used low-dose dopamine (5 μg/kg per min). Unfortunately, tachycardia developed, and the patient's dyspnea and intermittent desaturation did not improve. The patient also felt chest discomfort from palpitations. We changed the vasopressor to norepinephrine (5 μg/hr), which improved the patient's condition -her oxygen saturation was greater than 95% when she was in a supine position.The patient was successfully transferred to the tertiary care hospital, where she underwent implantation of a septal occluder. A follow -up cardiac echocardiogr...

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Section: Key Points Discussionmentioning

confidence: 99%

Cardiac platypnea-orthodeoxia syndrome in a 73-year-old woman

2015

CMAJ

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“…The platypnea-orthodeoxia syndrome was first described in 1949 by Burchell et al, [1]. It is not a stand-alone, single disease, but exactly a syndrome that has been reported in many diseases i.e., pneumonectomies [2], hepatopulmonary syndrome [3], adult respiratory distress syndrome [4] or intracardiac shunt [5].…”

Section: Discussionmentioning

confidence: 99%

“…A patent foramen ovale as underlying anatomical shunt is reported in 80% of the cases described in the medical literature [9]. A patent foramen ovale is usually asymptomatic, detected in a total of about 25% in adults [5,10,11]. Spontaneous right-to-left shunt through a patent foramen ovale visualized by color doppler.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Platypnea-Orthodeoxia Syndrome -An Echocardigraphic and Clinical Diagnosis

Pape¹

2015

CSMC

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“…On the other hand, even in the absence of pulmonary hypertension, conditions causing a localized increase in right atrial pressure and/or a reduction in the compliance of right chambers, such as pulmonary embolism, constrictive pericarditis, pericardial effusion, tricuspid stenosis, right atrial myxoma, and right ventricular dysfunction, play a role in the etiology of right-to-left shunt 5 , 6 , 9 .…”

Section: Discussionmentioning

confidence: 99%