European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

Pristipino, Christian; Germonpré, Peter; Toni, Danilo; Sievert, Horst; Meier, Bernhard; D’Ascenzo, Fabrizio; Berti, Sérgio; Onorato, Eustaquio; Bedogni, Francesco; Mas, Jean‐Louis; Scacciatella, Paolo; Hildick‐Smith, David; Gaïta, Fiorenzo; Kyrle, Paul A.; Thomson, John; Dérumeaux, Geneviève; Sibbing, Dirk; Chessa, Massimo; Hornung, Marius; Zamorano, José Luís; Dudek, Dariusz

doi:10.4244/eij-d-20-00785

Cited by 21 publications

(34 citation statements)

References 195 publications

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“…Esses pacientes geralmente apresentam síndrome de platipneia-ortodeoxia, uma doença rara caracterizada por dispneia e desoxigenação arterial induzida pela posição em pé e geralmente aliviada quando o paciente assume a posição supino. 2 …”

Section: Discussionunclassified

“…Propriamente dito, o diagnóstico de uma síndrome de desoxigenação arterial geralmente é um diagnóstico “por exclusão”. 2 Causas comuns de hipoxemia aguda, tais como pneumonia, insuficiência cardíaca aguda, embolia pulmonar ou outra doença pulmonar estrutural, devem ser excluídas primeiramente. No caso desse estudo, o ecocardiograma transtorácico não havia conseguido realizar o diagnóstico.…”

Section: Discussionunclassified

“…These patients usually present a platypnea-orthodeoxia syndrome, a rare condition characterized by dyspnea and arterial deoxygenation induced by an upright position and typically relieved by lying supine. 2 …”

Section: Discussionmentioning

confidence: 99%

“…As such, the diagnosis of an arterial deoxygenation syndrome is usually a “rule-out” diagnosis. 2 Common causes of acute hypoxemia must be first excluded, such as pneumonia, acute heart failure, pulmonary embolism, or other structural lung disease. In our case, transthoracic echocardiography had missed the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Uma Causa Rara de Hipoxemia após Cirurgia Ortopédica num Doente Idoso

Carvalho¹,

Meireles²,

Martins³

et al. 2022

Arquivos Brasileiros De Cardiologia

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Section: Discussionunclassified

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Uma Causa Rara de Hipoxemia após Cirurgia Ortopédica num Doente Idoso

Carvalho¹,

Meireles²,

Martins³

et al. 2022

Arquivos Brasileiros De Cardiologia

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“… 5 Patent foramen ovale closure should not be routinely performed in arterial deoxygenation syndromes but could be considered based on symptom severity and the pathogenic role of PFO in desaturation. 6 Atrial fibrillation is the most common post-procedural complication occurring in 4.6% of patients. 7 These data supported our decision to pursue AF ablation rather than PFO closure in this patient.…”

Section: Discussionmentioning

confidence: 99%

Paroxysmal supine hypoxaemia with hyperthyroidism and atrial fibrillation: a case report of a diagnostic challenge

Liu

Reddy

Niven

et al. 2022

European Heart Journal - Case Reports

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Background A patent foramen ovale (PFO) is a persistent embryonic defect in the interatrial septum. Platypnoea-orthodeoxia syndrome is characterized by positional hypoxaemia that is most commonly due to right-to-left shunting through a PFO. Dynamic right-to-left shunting through a PFO can also exacerbate positional hypoxaemia without platypnea-orthodeoxia syndrome. Case summary A 78-year-old woman with hyperthyroidism and paroxysmal atrial fibrillation (AF) presented with positional hypoxaemia exacerbated by supine positioning. Diagnostic testing revealed intermittent right-to-left shunting through a PFO triggered by worsening atrial functional tricuspid regurgitation and elevated right atrial pressures. Diuresis, rate control, and thyroidectomy initially led to resolution of positional hypoxaemia, but recurrent AF episodes triggered right-to-left shunting with recurrent desaturation. Left atrial and cavo-tricuspid isthmus ablation led to restoration of normal sinus rhythm and resolution of positional hypoxaemia without PFO closure. Discussion The clinical presentation of intermittent intracardiac right-to-left shunting can mimic decompensated heart failure with pulmonary oedema. Persistent hypoxaemia out of proportion to the degree of pulmonary oedema and minimally responsive to supplemental O2 should raise suspicion for right-to-left shunt aetiology. Positional arterial blood gases can facilitate the diagnostic evaluation of refractory hypoxaemia in cases of suspected shunting. Diagnostic imaging for PFO detection includes both transthoracic and transesophageal echocardiography with Valsalva manoeuver and agitated saline injection. Closure of a PFO for management of arterial deoxygenation syndromes should not be performed before treating other causes of arterial deoxygenation and optimizing factors that may exacerbate shunting across the PFO.

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Treatment Effects in Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale

Rigatelli

Zuin

2022

JAMA

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European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

Abstract: SpO 2 peripheral capillary oxygen saturation TCD transcranial Doppler TOE transoesophageal echocardiography VGE venous gaseous emboli

Cited by 21 publications

References 195 publications

Uma Causa Rara de Hipoxemia após Cirurgia Ortopédica num Doente Idoso

Uma Causa Rara de Hipoxemia após Cirurgia Ortopédica num Doente Idoso

Paroxysmal supine hypoxaemia with hyperthyroidism and atrial fibrillation: a case report of a diagnostic challenge

Treatment Effects in Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale

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