Cardiac Platypnea‐Orthodeoxia Syndrome: An Often Unrecognized Malady

Knapper, Joseph T.; Schultz, Jessica; Das, Gladwin S.; Sperling, Laurence

doi:10.1002/clc.22301

Cited by 55 publications

(65 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among the several conditions associated with POS, cardiac causes with right-to-left shunting are the most common 4 and require an anatomical and a functional component. 6 The anatomical defect is most commonly a PFO, but this causes a left-to-right shunt in the absence of elevated pulmonary pressures; therefore, the functional component is responsible for the inversion of the shunt, redirecting venous blood into the systemic circulation especially when the patient assumes an upright position.…”

Section: Discussionmentioning

confidence: 99%

“…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. 5 Herein we report a case of a patient who developed POS after a complicated cholecystectomy, which was found to be caused by a PFO and promptly resolved with a percutaneous transcatheter closure of the defect.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Platypnea-Orthodeoxia Syndrome After Complicated Cholecystectomy: An Unsuspected Diagnosis

2017

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Platypnea-Orthodeoxia Syndrome After Complicated Cholecystectomy: An Unsuspected Diagnosis

2017

View full text Add to dashboard Cite

show abstract

“…4,5 The syndrome can occur when a left-to-right shunt reverses in response to increased right atrial pressure or decreased right ventricular compliance 6,7 -as in the presence of kyphoscoliosis, 8 tortuous aortic root and ascending aorta, 9 aortic elongation, 10 or hemidiaphragmatic paralysis. 9 Symptoms are exacerbated by an upright position because increased septal stretching causes preferential flow from the inferior vena cava through the shunt and a secondary reduction of pulmonary blood flow.…”

Section: Discussionmentioning

confidence: 99%

Platypnea-Orthodeoxia Syndrome: Diagnostic Challenge and the Importance of Heightened Clinical Suspicion

Henkin

Negrotto

Pollak³

et al. 2015

Texas Heart Institute Journal

View full text Add to dashboard Cite

P latypnea-orthodeoxia syndrome (POS) is an uncommon condition of positional dyspnea (platypnea) and hypoxemia (orthodeoxia). The symptoms occur when the patient is upright and resolve quickly with recumbency. These findings are the opposite of those typically seen in cases of advanced heart failure and can pose a diagnostic dilemma.Even though POS was first described in the late 1940s, 1 the pathophysiologic triggers of orthodeoxia and platypnea are still not completely understood. It appears that both a functional component and an anatomic component are required.2 The syndrome has been associated with cardiac, pulmonary, abdominal, and vascular disease (functional component) in conjunction with a shunt (anatomic component). 2 The most frequently described cause is right-to-left interatrial shunting from a patent foramen ovale (PFO) or an atrial septal defect (ASD) in the presence of pulmonary hypertension.3 Positional variation in the degree of shunting in these situations remains incompletely understood. It is believed that the upright position changes or stretches the conformation of the interatrial communication, increasing the proportion of blood flow from the inferior vena cava through the defect and into the left atrium. 3 We report our experience in treating a patient who presented with POS in the absence of substantial pulmonary hypertension. Case ReportIn September 2013, an 83-year-old woman with a history of paroxysmal atrial fibrillation was admitted to the hospital after several weeks of progressive positional dyspnea that worsened with standing and improved with lying supine. On admission, the patient's pulse oximetry on room air was 96% while supine and 81% while standing. Physical examination was noteworthy for marked kyphoscoliosis. Computed tomographic evaluation for lung disease revealed a tortuous thoracic aorta with otherwise normal lung parenchyma. The patient's arterial blood gases on room air showed a significant drop in arterial oxygen tension upon postural change (from lying down to standing), confirming our suspicion of POS (Table I).A transthoracic echocardiogram revealed normal pulmonary artery pressure, with an atrial bidirectional shunt. A transesophageal echocardiogram revealed an ASD of moderate size (area, 2.2 cm 2 ) (Fig. 1), together with bidirectional shunting while the patient was supine and sedated.

show abstract

“…The PFO was closed surgically and the patient's symptoms quickly resolved 39. Several other case reports indicate successful correction of the hypoxemia and symptoms after PFO closure 38, 40, 41. Mojadidi et al prospectively studied 683 patients with PFO‐associated conditions, of which 17 (2.5%) had POS and had elected to close their PFO.…”

Section: Other Potential Indications For Pfo Closurementioning

confidence: 97%