An extreme case of platypnoea-orthodeoxia syndrome

O’Gallagher, Kevin; Chou, Evelyn; Jeyabraba, Swarna; Sinha, Aish; Robb, Daniel; Byrne, Jonathan

doi:10.7861/clinmedicine.16-5-453

Cited by 1 publication

(2 citation statements)

References 6 publications

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“…There have been several case reports, which report many causes that lead to an accentuated right-to-left shunt in patients with an existing intracardiac shunt, and therefore, platypnoea and orthodeoxia. These include aortic atherosclerosis and subsequent elongation of the ascending aorta and aortic root dilation, progressive kyphosis, pneumonectomy, lobectomy, constrictive pericarditis, pericardial effusion, pulmonary embolism, diaphragmatic paralysis causing cardiac compression and after transcatheter closure of ruptured sinus of valsalva 2 4–6 8–11…”

Section: Discussionmentioning

confidence: 99%

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Reversible platypnoea-orthodeoxia syndrome

Joseph,

Isaac,

James

et al. 2023

BMJ Case Rep

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Platypnoea-orthodeoxia syndrome is characterised by dyspnoea and oxygen desaturation in the upright position usually caused by an extracardiac shunt and less often due to dynamic factors that accentuate an intracardiac right-to-left shunt. In our patient, the collapse of lower lobe of left lung secondary to bronchial stenosis due to endobronchial tuberculosis and resultant mediastinal shift was the factor that led to an otherwise unrecognised intracardiac right-to-left shunt leading to platypnoea-orthodeoxia. We postulate that there would have been an increased stretching and widening of a patent foramen ovale in the upright position due to gravity resulting in an increased shunt despite normal intracardiac pressures. Once the patency of the left main bronchus was restored by deploying a stent, the left lower lobe expanded, the mediastinum returned to its normal position and there was resultant resolution of the platypnoea-orthodeoxia. This interesting observation may be useful in managing similar scenarios in the future.

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Section: Discussionmentioning

confidence: 99%

“…In the upright position, there was further increased stretching and widening of the defect aided by gravity permitting the shunt even at normal intracardiac pressures. It, therefore, manifested as a position-dependent and flow-mediated opening of the patent foramen ovale resulting in an augmented right-to-left shunt 2 5 10–12…”

Section: Discussionmentioning

confidence: 99%