Sudden Onset of Platypnea-Orthodeoxia Syndrome Caused by Traumatic Tricuspid Regurgitation With Ruptured Chordae Tendineae After Blunt Chest Trauma

Abstract

An 86-year-old man was admitted our hospital because of sudden onset of dyspnea after blunt chest trauma. Because his oxygen saturation deteriorated from 92% in the supine position to 86% in the sitting position, platypnea-orthodeoxia syndrome was suspected. Transesophageal echocardiography showed severe tricuspid regurgitation (TR) caused by anterior papillary muscle rupture. Furthermore, right-to-left shunt with TR through a patent foramen ovale (PFO) was observed. The diagnosis was therefore platypnea-orthodeoxia syndrome with right-to-left shunt through PFO with shunting exacerbated by acute severe TR after blunt chest trauma. The patient underwent urgent tricuspid valve repair and PFO closure and has remained asymptomatic postoperatively.

Tricuspid valve repair via partial sternotomy for traumatic valve insufficiency

“…In the review of five surgical cases reported in Japan from 2010 to 2018, the types of trauma were the motorcycle accidents in two cases and the other cases were fall, horse kick, and penetrating trauma. [1][2][3][4][5] It is notable that all patient in this series had anterior leaflet pathology. Blunt chest trauma accompanying the tremendous impact on the chest wall easily injures the anterior leaflet chordae and papillary muscle because the constructions are attached to the right heart free wall.…”

Platypnea-orthodeoxia syndrome after open prostatectomy and cystolithotomy: Coincidence or unknown pathophysiology?

“…Most cases of POS previously described in the literature had a more progressive installation, with dyspnea being the most important complaint developing over weeks to years. Acute POS cases are usually associated with acute anatomical thoracic changes due to trauma 5,6 or surgery. 7,9,10 In this case report, we highlight the sudden and disproportional degree of hypoxemia in relation to the degree of symptoms.…”

“…1,2 The most common pathophysiology of POS involves an intermittent and dynamic right-toleft cardiac shunt triggered by anatomical changes in the position of the atria in the presence of a patent foramen ovale (PFO) and usually in the absence of pulmonary hypertension. These anatomical changes may include a progressive dilation of the ascending aorta 3,4 or can be induced more acutely by thoracic trauma 5,6 and thoracic 7 or upper abdominal surgeries, [8][9][10] among others. In this report, we describe a case of acute-onset hypoxemia due to POS in a patient before a surgical urologic intervention that became severe after surgery with no obvious cause.…”

Platypnea-Orthodeoxia Syndrome Associated with Spontaneously Ruptured Chordae Tendineae of Tricuspid Valve

“…Generally, rupture of the chordae tendineae of the tricuspid valve is primarily induced by blunt chest trauma, and previous reports have described the occurrence of tricuspid chordal rupture due to trauma. [6][7][8][9] Although other etiologies have been reported (e.g., infective endocarditis, myocardial infarction, congenital disorders, 10,11 iatrogenic complication of endomyocardial biopsy 12,13 ), only a few studies have described spontaneous tricuspid chordal rupture. 14,15 Irrespective of the cause, POS induced by rupture of the chordae tendineae of the tricuspid valve should be rapidly diagnosed to promptly proceed with the adequate surgery needed to resolve the hemodynamic compromise.…”