Platypnoea Orthodeoxia Syndrome and Patent Foramen Ovale Closure: Single-Centre Experience and Long-Term Follow-Up

Castro, Ana Gama e; Luz, André; Oliveira, Filomena; Brochado, Bruno; Santos, Raquel; Alexandre, André; Campinas, Andreia; Couto, David Sá; Silveira, João; Torres, Severo

doi:10.1016/j.hlc.2022.07.003

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…The treatment for patients with platypnea-orthodeoxia due to intracardiac shunts involves closing the shunt itself [19][20][21][22][23][24][25]. Many of the patients reviewed in our study underwent subsequent cardiac repair with shunt closure.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Aortic Root Pathologies in Platypnea-Orthodeoxia Syndrome Secondary to Intra-Cardiac Shunts

Farooq,

Ghani,

Friedman

et al. 2024

Cardiol Res

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Background: Atrial septal defects can allow right to left shunting of venous blood which presents clinically as platypnea-orthodeoxia syndrome. It is believed that concomitant presence of aortic root pathologies increases the likelihood of shunting. Methods:The study included a review of 510 articles listed in Pub-Med of patients with platypnea-orthodeoxia syndrome. Case reports of patients with extra-cardiac etiologies of platypnea-orthodeoxia were excluded. Results:We reviewed 191 case reports, and 98 cases (51.3%) had evidence of concomitant aortic root pathology. Furthermore, of the remaining 93 case reports, 69 ones excluded any mention of the nature of the aortic root altogether, further suggesting that this is an underreported number. Conclusions:There is a high prevalence of aortic root pathologies in patients with platypnea-orthodeoxia syndrome secondary to intra-cardiac shunts. In patients with unexplained hypoxemia and incidental finding of aortic root pathology, it may be worthwhile to obtain postural oxygen saturation measurements to exclude intra-cardiac shunts as the potential cause.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Aortic Root Pathologies in Platypnea-Orthodeoxia Syndrome Secondary to Intra-Cardiac Shunts

Farooq,

Ghani,

Friedman

et al. 2024

Cardiol Res

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“…However, owing to the heterogeneity of the underlying mechanisms, there is no consensus on the causative mechanism for this condition. 19 POS is sometimes noted during failed attempts to wean patients from mechanical ventilation. Coughing, sneezing, Valsalva maneuvers, and mechanical ventilation can alter venous return and right atrial pressures to cause an RLS across the IAS and lead to hypoxemia.…”

Section: Platypnea-orthodeoxia Syndromementioning

confidence: 99%

“…However, pressure gradients by themselves do not adequately describe this condition. 19,20 Interestingly, pulmonary pressures in most patients with POS are either normal or minimally elevated. Careful attention must be given to the location of the shunt in these patients as a similar aggregate of symptoms may be present in patients with only intrapulmonary shunts leading to the diagnosis of hepatopulmonary syndrome that would not benefit from atrial septal interventions.…”

Section: Platypnea-orthodeoxia Syndromementioning

confidence: 99%

“…30 POS is likely a heterogeneous disorder caused by any of the aforementioned abnormalities. 19,20 Evidence. Clinical data on management of POS with shunt closure largely come from case series.…”

Section: Platypnea-orthodeoxia Syndromementioning

confidence: 99%

“…All patients experienced improvement in dyspnea with upright SpO 2 improving from 91.5% to >95.1% and resolution of need for supplemental oxygen in all but 1 patient. 19 Mojadidi et al 32 reported 17 patients between 2001 and 2012 diagnosed with POS and a PFO with RLS in whom follow-up was available. Unlike other studies, 58.8% of patients had significant underlying lung pathologies including chronic obstructive pulmonary disease and pulmonary hypertension with 4 patients on bosentan or sildenafil, and 23.5% of patients had diaphragmatic paralysis.…”

Section: Platypnea-orthodeoxia Syndromementioning

confidence: 99%

See 2 more Smart Citations

Patent Foramen Ovale Closure for Nonstroke Indications

Honasoge,

Suradi,

Tobis

et al. 2023

Journal of the Society for Cardiovascular Angiography & Int

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Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management

Apostolos,

Tsiachris,

Drakopoulou

et al. 2024

JAHA

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This comprehensive review explores the incidence, pathophysiology, and management of atrial fibrillation (AF) following percutaneous closure of patent foramen ovale (PFO). Although AF is considered a common adverse event post PFO closure, its incidence, estimated at <5%, varies based on monitoring methods. The review delves into the challenging task of precisely estimating AF incidence, given subclinical AF and diverse diagnostic approaches. Notably, a temporal pattern emerges, with peak incidence around the 14th day after closure and a subsequent decline after the 45th day, mimicking general population AF trends. The pathophysiological mechanisms behind post PFO closure AF remain elusive, with proposed factors including local irritation, device‐related interference, tissue stretch, and nickel hypersensitivity. Management considerations encompass rhythm control, with flecainide showing promise, and anticoagulation tailored to individual risk profiles. The authors advocate for a personalized approach, weighing factors like age, comorbidities, and device characteristics. Notably, postclosure AF is generally considered benign, often resolving spontaneously within 45 days, minimizing thromboembolic risks. Further studies are required to refine understanding and provide evidence‐based guidelines.

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Platypnoea Orthodeoxia Syndrome and Patent Foramen Ovale Closure: Single-Centre Experience and Long-Term Follow-Up

Cited by 4 publications

References 23 publications

Prevalence of Aortic Root Pathologies in Platypnea-Orthodeoxia Syndrome Secondary to Intra-Cardiac Shunts

Prevalence of Aortic Root Pathologies in Platypnea-Orthodeoxia Syndrome Secondary to Intra-Cardiac Shunts

Patent Foramen Ovale Closure for Nonstroke Indications

Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management

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