Platypnoea-orthodeoxia syndrome

Kubler, Paul; Gibbs, Harry; Garrahy, P.

doi:10.1136/heart.83.2.221

Cited by 63 publications

(37 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…POS has been reported in association with intracardiac and intrapulmonary shunting [1]. This case describes a patient who presented with hypoxaemia and platypnoea and investigations showed an interatrial defect with right to left shunt, without pulmonary hypertension.…”

Section: Introductionmentioning

confidence: 94%

Platypnoea-orthodeoxia syndrome due to right to left interatrial shunting despite normal intracardiac pressures

Karunatilake¹,

Vithiya²,

Jeevagan³

et al. 2010

Ceylon Med. J.

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 94%

Platypnoea-orthodeoxia syndrome due to right to left interatrial shunting despite normal intracardiac pressures

Karunatilake¹,

Vithiya²,

Jeevagan³

et al. 2010

Ceylon Med. J.

View full text Add to dashboard Cite

“…The cause of the right to left shunt with normal intracardiac pressures through an interatrial communication has not yet been completely clarified and, although very complex diagnostic tools are available, a series of questions remain unanswered as to the physiopathology and the anatomical and physiological substrate that can explain this picture [1][2][3] .…”

Section: Case Reportmentioning

confidence: 99%

Shunt direita-esquerda através de forame oval patente sem hipertensão pulmonar

Lisboa¹,

Costa²,

Furian³

et al. 2007

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

ECG without ischemic alterations; chest X-ray showing pleural calcifications; and chest angiotomography with no evidence of pulmonary thromboembolism.He had progressive worsening of hypoxemia, and had to be admitted into the intensive care unit (ICU), at first with non-invasive mechanical ventilation and later with invasive mechanical ventilation, with two unsuccessful extubation attempts.The investigation also included the following: pulmonary perfusion scintilography, with low probability of pulmonary thromboembolism; Doppler of lower limbs with no evidence of deep venous thrombosis; high resolution chest tomography showing no alterations that justified his degree of hypoxemia; transthoracic echocardiogram with air contrast, showing interatrial septal aneurysm, with intense and early passage of contrast to the left cavities, which is compatible with a patent foramen ovale, with no evidence of pulmonary arterial hypertension; enlarged left ventricle, with a relaxation deficit, and preserved global and segmental systolic function and with ejection fraction (EF) = 66%; transesophageal echocardiogram with Doppler, with evidences of a patent foramen ovale, with a predominant right to left flow, without intracavity thrombus; pulmonary arteriography with absence of intrapulmonary shunt.With the presumptive diagnosis of hypoxemia secondary to the right to left shunt through the patent foramen ovale, we installed a pulmonary artery catheter and performed blood gas analysis. Later we performed cardiac catheterization and measured oxygen saturation in the heart chambers (Tab. 1).As the patient continued to present desaturation when in a seated position and therefore required mechanical ventilation despite the absence of a right left pressure gradient, he underwent surgical repair of the patent foramen ovale (atrioseptoplasty) (Fig. 1). In addition to the patent foramen ovale, no other alteration was identified in the interatrial septum. The patient progressed with substantial improvement in hypoxemia. He was extubated in the first postoperative period, and discharged from the ICU and from hospital without symptoms; his condition has been stable for six months.Cases of hypoxemia secondary to right to left shunt through a patent foramen ovale in the absence of pulmonary hypertension are rarely described in the literature and may constitute a picture of platypnea-orthodeoxia syndrome 1 . In this paper we will describe the case of a patient with this rare condition. Case ReportA 71-year old white male patient, married, was admitted to the Emergency Room of HCPA due to major dyspnea at rest, with no associated symptoms. He reported having progressive dyspnea for ten months, which became more intense ten days before admission.His previous medical history included: smoking from 31 to 35 years of age; thoracic bruise with no sequela 25 years ago; systemic arterial hypertension since 1985, treated with Amlodipine, Hydrochlorothiazide and Enalapril; dyslipidemia since 1996, treated with Sinvastatin and gastroesophageal reflux dise...

show abstract

“…[1][2][3][4][5] Standing upright stretches an interatrial communication, such as a patent foramen ovale or ASD, allowing more venous blood to stream from the inferior vena cava through the defect. 5 Furthermore, an aortic aneurysm 9 or an elongated ascending aorta 10 may rotate the heart and distort the position of the atrial septum relative to caval inflow.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore he was diagnosed as having P-O syndrome. [1][2][3][4][5] The patient gave his informed consent, we decided to surgically close the ASD, which was approximately 0.8× 1.0 cm in diameter and consisted of 2 defects (Fig 6). Direct closure of the defects was carried out and soon after the operation, the dyspnea and hypoxemia that occurred while upright completely resolved.…”

mentioning

confidence: 99%