Platypnea-Orthodeoxia Syndrome in an Elderly Patient Treated with Percutaneous Patent Foramen Ovale Closure: Report of a Case and Review of the Literature

Introduction: Platypnea-Orthodeoxia syndrome is characterized by dyspnea and hypoxia in the upright position, usually improving in the supine position. Two components are required: an interatrial or intrapulmonary shunt, and a functional component. Diagnosis is made by contrast ultrasonography. We report a case of Platypnea-Orthodeoxia syndrome revealed by positional dyspnea in an 87-year-old patient. The aim of this study is to describe the clinical, therapeutic and evolutionary profile of this syndrome. Case Presentation: This is an 87-year-old patient with a history of pulmonary embolism (PE) and stroke. He was seen for dyspnea and desaturation in orthostatism, revealing a patent foramen ovale (PFO). Progression was favorable after closure of the PFO. Conclusion: Platypnea-Orthodeoxia syndrome may be presented as simple exertional dyspnea. The clinician should check for improvement in symptoms and/or oxygenation during decubitus. Definitive treatment consists of percutaneous closure of the shunt.

Ischemic Stroke Due to Paradoxical Embolism in a Patient with Patent Foramen Ovale, Bilateral Distal Deep Vein Thrombosis and Platypnea-Orthodeoxia Syndrome: A Case Report

Patent foramen ovale (PFO) is a common congenital cardiac defect. It is usually asymptomatic, but it can be associated with relevant clinical manifestations such as cryptogenic stroke and platypnea-orthodeoxia syndrome. We present the case of a patient with hemodynamically significant carotid artery stenosis who underwent endarterectomy for a transient ischemic attack (TIA). After surgery, the patient presented an ischemic stroke due to M2 occlusion treated with mechanical thrombectomy. During hospitalization, a distal bilateral deep vein thrombosis was found. The patient developed respiratory failure due to a massive right-to-left shunt through a large PFO (platypnea-orthodeoxia syndrome). These findings are consistent with the hypothesis that the TIA and the subsequential ischemic stroke were related to paradoxical embolism rather than atherothromboembolism. The aim of our case report is to raise awareness of the possible complications of such a common finding as PFO.

Platypnea-orthodeoxia syndrome in a patient with a pre-existing patent foramen ovale successfully treated with an atrial septal occluder

Platypnea orthodeoxia syndrome is associated with dyspnea and arterial oxygen desamration accentuated by an upright posture. It can be secondary to an intracardiac shunt. We report a case of platypnea-orthodeoxia syndrome （POS） in a 58-year old male patient who had a pre-existing patent foramen ovale （PFO） and substantial pulmonary pathologies. He was successfully treated by percutaneous transcatheter closure of the PFO. Our case highlights the importance of recognition of this rare syndrome in patients who present with unexplained hy- poxia for whom transcatheter closure of the interatrial shunt can be safely carded out.

Uncommon late presentation of platypnea-orthodeoxia syndrome

A 79-year-old man presented with progressive dyspnea, gradually worsening over a period of several weeks. His past medical history included hypertension, chronic hepatitis C without cirrhosis, ischemic stroke occurred at the age of 68 and chronic obstructive pulmonary disease （COPD） caused by long-term cigarette smoking. The patient was alert and oriented and not in acute distress. The physical examination of the chest revealed decreased breath sounds at the bases of the lungs, without crackles or wheezes. Heart sounds were regular without murmurs. The respiration rate was normal.

An uncommon cause of hypoxemia： platypnea-orthodeoxia syndrome

Platypnea-onhodeoxia syndrome （POS） describes a clinical entity of arterial hypoxemia in the upright position associated with dyspnoea, which is relieved by recumbency. The syndrome is caused by an intracardiac or intrapulmonary shunt, or ventilation-perfusion mismatching. We describe here the first case of resolving/relapsing POS induced by intracardiac right-to-left shunting that was partly dependent on volume overload.

斜卧呼吸-直立性低氧血症综合征机制与诊疗研究进展

斜卧呼吸-直立性低氧血症综合征的特征是站立位时引发呼吸困难和低氧血症,仰卧位可缓解。目前该疾病的具体机制尚未明确,但大多数已报道的病例都和心内分流或肺内分流相关,前者主要包括房间隔解剖学缺损,伴随其他解剖异常和右心压力升高,后者主要包括通气/血流不匹配和血管畸形。诊断该疾病通常需充分的临床评估和完善的相关检查,对于大多数心内分流和部分肺内分流患者,手术治疗后效果尚可。现就该疾病的机制及诊疗相关研究进展进行综述。