Platypnea-Orthodeoxia Syndrome Related to an Aortic Aneurysm Combined With an Aneurysm of the Atrial Septum

Faller, M; Kessler, Romain; Chaouat, Ari; Ehrhart, M; Petit, H.; Weitzenblum, E

doi:10.1378/chest.118.2.553

Cited by 66 publications

(46 citation statements)

References 30 publications

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“…Even if an interatrial communication (PFO or ASD) is necessary for cardiac POS development, and ASA or prominent Eustachian valve act as contributing factors, the main cause for right-to-left shunt development is right chamber anatomy modification in later life [16]. Several mechanical conditions -mainly right diaphragmatic paralysis and ascension [17,18], kyphoscoliosis [19], restrictive lung disease, previous pneumonectomy [4,5,20], pleural effusion, and ectatic/aneurysmal ascending aorta [21,22] -may lead to atrial chamber or septum deformity, thus changing the anatomic relationship between the atrial septum and the inferior vena cava and therefore facilitating desaturated blood flow redirection through the PFO. In our case series, the septum anatomical modifications were due to aortic dilatation, right diaphragmatic paralysis and ascension, restrictive lung disease and kyphoscoliosis.…”

Section: Discussionmentioning

confidence: 99%

Platypnea–orthodeoxia syndrome in the elderly treated by percutaneous patent foramen ovale closure: A case series and literature review

Blanche

Noble

Roffi

et al. 2013

European Journal of Internal Medicine

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Background: Platypnea-orthodeoxia syndrome (POS) is a rare clinical phenomenon, associating normal oxygen saturation in a supine position and arterial hypoxemia in an upright position. This pathology can be secondary to an intracardiac shunt, a pulmonary vascular shunt or a ventilation-perfusion mismatch. Cardiac POS occurs in the presence of a right-to-left cardiac shunt, most commonly through a patent foramen ovale (PFO). Methods and results: From our single-center prospective database of percutaneous PFO closure we identified five patients (4 females, mean age: 77 ± 11 years) out of 224 (2.2%) patients with a PFO who presented with a POS of cardiac origin. Transthoracic and transoesophageal echocardiographic examinations revealed the underlying mechanisms of POS and the diagnosis was confirmed by right-and-left cardiac catheterization (RLC) and by measuring serial blood oxygen saturation in the pulmonary veins and left atrium in supine and upright positions. PFO was associated with atrial septal aneurysm and a persistent prominent Eustachian valve in 3 patients. All patients underwent a successful percutaneous PFO closure without any immediate or subsequent complications (mean follow-up of 24 ± 18 months). Immediately after the procedure, mean arterial oxygen saturation improved from 83% ± 3 to 93% ± 2 in an upright position and symptoms disappeared. Conclusion: POS is a rare and under-diagnosed pathology that must be actively investigated in the presence of position-dependent hypoxemia. The diagnostic work-up must exclude other causes of hypoxemia and confirm the intracardiac shunt using either contrast echocardiography or RLC. For cardiac POS, percutaneous PFO closure is a safe and effective technique that immediately relieves orthodeoxia and patient symptoms.

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Section: Discussionmentioning

confidence: 99%

Platypnea–orthodeoxia syndrome in the elderly treated by percutaneous patent foramen ovale closure: A case series and literature review

Blanche

Noble

Roffi

et al. 2013

European Journal of Internal Medicine

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“…This abnormal anatomic relationship between the vena cava and the atrial septum increases in the upright position, directing preferentially the venous blood through the atrial septal defect. This phenomenon is known as platypnea [5]. We did not measure arterial blood gas values in the upright position, a maneuver which could have demonstrated an orthodeoxia.…”

Section: Discussionmentioning

confidence: 99%

Right-to-Left Atrial Shunt without Pulmonary Artery Hypertension

Gouitaa

Vaillant²,

Leude³

et al. 2002

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A 70-year-old woman without any history of pulmonary or cardiac disease developed breathlessness with severe arterial hypoxemia. Cardiac ultrasound examination and spirometry were normal. Cardiac catheterization and intravenous microbubble injection demonstrated an interatrial right-to-left shunt. The defect was closed surgically, and the patient recovered immediately. On surgery, the aorta was elongated, inducing an angulation of the interatrial septum and leading to the atrial septal defect just above the inferior vena cava.

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“…Recently, FALLER et al [4] described a right-to-left shunt through a PFO in association with both an atrial septum aneurysm and a thoracic aorta aneurysm. SORRENTINO et al [5] described a case of platypnoea and orthodeoxia caused by right-to-left shunting across a PFO in a patient with normal pulmonary artery pressure and normal heart function.…”

Section: Discussionmentioning

confidence: 99%

Patent foramen ovale causing position-dependent shunting in a patient, when laying down her corset

et al. 2001

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A 75-yr-old female presented with platypnoea and orthodeoxia, shortly after laying down an old and pinching corset. The injection of activated Haemaccel in the right cubital vene during transoesophageal echocardiography, in the upright position, revealed a direct blood flow from the superior caval vein at a patent foremen ovale, consequently opening it and causing a large right-to-left shunt which was calculated at 28.5%. In the supine position there was only a minimal opening of the patent foremen ovale with a calculated right-to-left shunt of 9.5%. The patent foremen ovale was successfully closed percutaneously with a CardioSEAL TM .

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Platypnea-Orthodeoxia Syndrome Related to an Aortic Aneurysm Combined With an Aneurysm of the Atrial Septum

Cited by 66 publications

References 30 publications

Platypnea–orthodeoxia syndrome in the elderly treated by percutaneous patent foramen ovale closure: A case series and literature review

Platypnea–orthodeoxia syndrome in the elderly treated by percutaneous patent foramen ovale closure: A case series and literature review

Right-to-Left Atrial Shunt without Pulmonary Artery Hypertension

Patent foramen ovale causing position-dependent shunting in a patient, when laying down her corset

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