1
|
Farooq O, Ghani U, Friedman H, Akbar MS, Saudye H, Alam S, Khan MJ, Mutti S. Prevalence of Aortic Root Pathologies in Platypnea-Orthodeoxia Syndrome Secondary to Intra-Cardiac Shunts. Cardiol Res 2024; 15:125-128. [PMID: 38645826 PMCID: PMC11027782 DOI: 10.14740/cr1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
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 PubMed 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.
Collapse
Affiliation(s)
- Omer Farooq
- Internal Medicine, Ascension St Francis Hospital, Evanston, IL 60202, USA
| | - Usman Ghani
- Northwest General Hospital and Research Center, Peshawar, Pakistan
| | - Harvey Friedman
- Pulmonary and Critical Care Medicine, Ascension St Francis Hospital, Evanston, IL 60202, USA
| | | | - Hammad Saudye
- Interventional Cardiology, Ascension St Francis Hospital, Evanston, IL 60202, USA
| | - Sundus Alam
- Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK
| | | | - Sumeet Mutti
- Internal Medicine, Ascension St Francis Hospital, Evanston, IL 60202, USA
| |
Collapse
|
2
|
Thomas CH, Zampi JD, Joynt MR. Sinus venosus atrial septal defect presenting with platypnea-orthodeoxia syndrome in the setting of COVID-19 infection. Cardiol Young 2024:1-3. [PMID: 38439641 DOI: 10.1017/s1047951124000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Platypnea-orthodeoxia syndrome is characterised by hypoxemia and dyspnoea while upright that resolves when supine, typically associated with an interatrial communication. We present a case of platypnea-orthodeoxia syndrome associated with a sinus venosus atrial septal defect in a patient with multiple possible aetiologies of hypoxemia, including COVID-19 infection. Cardiac catheterisation with provocative maneuvers confirmed the diagnosis and symptoms resolved following defect closure. We suggest that in patients with platypnea-orthodeoxia syndrome, it is useful to obtain haemodynamic data while supine and upright.
Collapse
Affiliation(s)
- Courtney H Thomas
- Congenital Heart Center at CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey D Zampi
- Congenital Heart Center at CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Michael R Joynt
- Congenital Heart Center at CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Othman F, Bailey B, Collins N, Lau E, Tanous D, Rao K, Celermajer D, Cordina R. Platypnea-Orthodeoxia Syndrome in the Setting of Patent Foramen Ovale Without Pulmonary Hypertension or Major Lung Disease. J Am Heart Assoc 2022; 11:e024609. [PMID: 35876406 PMCID: PMC9375500 DOI: 10.1161/jaha.121.024609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Patent foramen ovale (PFO)‐associated platypnea‐orthodeoxia syndrome is characterized by dyspnea and hypoxemia when upright. The pathogenesis is thought to involve an increase in right atrial pressure or change in degree of right to left shunting with upright posture. Methods and Results We sought to characterize patients with platypnea‐orthodeoxia syndrome related to PFO without pulmonary hypertension. We retrospectively reviewed databases at 3 tertiary referral hospitals in New South Wales, Australia from 2000 to 2019. Fourteen patients with a mean age of 69±14 years had a PFO with wide tunnel separation. Mean New York Heart Association Classification was II (±0.9) and 7 inpatients had been confined to bed (from postural symptoms). Baseline oxygen saturations supine were 93%±5% and 84%±6% upright. Two patients had a minor congenital heart defect and 4 had mild parenchymal lung disease with preserved lung function. The mean aortic root diameter was 37±6 mm and distance between aortic root and posterior atrial wall was 16±2 mm. Platypnea‐orthodeoxia syndrome was preceded by surgery in 5 patients and 1 patient had mild pneumonia. Successful closure of the PFO using an Amplatzer device was performed in 11 of 14 patients. Post‐closure, all patients had New York Heart Association Classification I (improvement 1.6±0.9, P<0.003) and semi‐recumbent oxygen saturations increased by 13%±8% (P<0.001, n=10). Conclusions Platypnea‐orthodeoxia syndrome is a debilitating condition, curable by PFO closure. Anatomical distortion of the atrial septum related to a dilated aortic root or shortening of the distance between the aortic root and posterior atrial wall may contribute to the syndrome.
Collapse
Affiliation(s)
| | - Brian Bailey
- Royal Prince Alfred Hospital Sydney NSW Australia
| | | | - Edmund Lau
- Royal Prince Alfred Hospital Sydney NSW Australia
| | - David Tanous
- Royal Prince Alfred Hospital Sydney NSW Australia.,Westmead Hospital Sydney NSW Australia
| | - Karan Rao
- Westmead Hospital Sydney NSW Australia
| | - David Celermajer
- Royal Prince Alfred Hospital Sydney NSW Australia.,Heart Research Institute Sydney NSW Australia.,Sydney Medical SchoolUniversity of Sydney NSW Australia
| | - Rachael Cordina
- Royal Prince Alfred Hospital Sydney NSW Australia.,Heart Research Institute Sydney NSW Australia.,Sydney Medical SchoolUniversity of Sydney NSW Australia
| |
Collapse
|
4
|
Pöyhönen P, Kuusisto J, Pirinen J, Räty H, Lehmonen L, Paakkanen R, Martinez-Majander N, Saeed S, Gerdts E, Putaala J, Sinisalo J, Järvinen V. Orientation of the atrial septum to the inferior vena cava may contribute to the persistent patency of the foramen ovale. Cardiology 2022; 147:169-178. [DOI: 10.1159/000522017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 01/13/2022] [Indexed: 11/19/2022]
Abstract
Purpose: There is growing evidence that paradoxical embolism through patent foramen ovale (PFO) is a cause for cryptogenic stroke. However, it is still unclear why the foramen ovale fails to close after birth. We studied whether the 3D relations between the atrial septum and the inferior vena cava (IVC) are associated with PFO.
Methods: We recruited 30 patients (18-49 years) with a first-ever cryptogenic stroke and 30 age- and sex-matched stroke-free controls. Using cardiac magnetic resonance (CMR), an approach to evaluate the 3D relations between the atrial septum and the IVC was developed. The presence of interatrial right-to-left shunt was evaluated with transesophageal echocardiography (TEE) in patients and transcranial Doppler in controls.
Results: Of 30 patients, 29 underwent successful TEE, of which 12 (41%) had a shunt. Patients with a shunt had a greater mean 3D angle (γ) between the atrial septal plane and the vector from the orifice of the IVC to the middle of the atrial septum compared with patients without a shunt (45±9° vs. 36±8°, p=0.017). Of 30 controls, 12 (40%) had a shunt and a greater mean γ compared with controls without a shunt (47±8° vs. 37±10°, p=0.007). In a pooled analysis, 24 (41%) of 59 subjects with a shunt had a mean γ of 46±9° compared with subjects without a shunt of 37±9° (p<0.001).
Conclusions: More perpendicular orientation of the atrial septal plane to the orifice of the IVC is associated with PFO, possibly by directing the IVC flow to PFO.
Collapse
|
5
|
Heidemann A, Dall'Oglio L, Bertoldi EG, Foppa M. Increased Mobility of the Atrial Septum in Aortic Root Dilation: An Observational Study on Transesophageal Echocardiography. Front Physiol 2021; 12:701399. [PMID: 34504436 PMCID: PMC8421672 DOI: 10.3389/fphys.2021.701399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: There is a growing interest in the relationship between atrial septal anatomy and cardioembolic stroke. Anecdotal reports suggest that the enlargement of the aortic root could interfere with atrial septal mobility (ASM). We sought to investigate the association between ASM and aortic root dilation. Methods and Findings: From all consecutive clinically requested transesophageal echocardiogram (TEE) studies performed during the study period in a single institution, we were able to review and evaluate the ASM and anteroposterior length, aortic root diameter, and the prevalence of atrial septal aneurysm (ASA) and of patent foramen ovale (PFO) in 336 studies. Additional variables, such as left ventricular ejection fraction, left atrial diameter, diastolic dysfunction, age, sex, weight, height, previous stroke, atrial fibrillation, and TEE indication, were extracted from patient medical records and echocardiographic clinical reports. In 336 patients, we found a mean ASM of 3.4 mm, ranging from 0 to 21 mm; 15% had ASA and 14% had PFO. There was a 1.0 mm increase in ASM for every 10-mm increase in aortic root diameter adjusted for age, sex, weight, height, ejection fraction, and left atrial size (B = 0.1; P = 0.04). Aortic diameter was not associated with a smaller septal length (B = 0.03; P = 0.7). Conclusion: An increased motion of the atrial septum can occur in association with aortic dilation. These findings deserve attention for the relevance of aortic root anatomy in future studies involving atrial septal characteristics and embolic stroke risk.
Collapse
Affiliation(s)
- Altair Heidemann
- Graduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,NUPIC (Núcleo de Pesquisa em Imagem Cardiovascular), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lorença Dall'Oglio
- NUPIC (Núcleo de Pesquisa em Imagem Cardiovascular), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Luterana do Brasil, Porto Alegre, Brazil
| | - Eduardo Gehling Bertoldi
- Graduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,School of Medicine, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Murilo Foppa
- Graduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,NUPIC (Núcleo de Pesquisa em Imagem Cardiovascular), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
6
|
Pristipino C, Germonpré P, Toni D, Sievert H, Meier B, D'Ascenzo F, Berti S, Onorato E, Bedogni F, Mas JL, Scacciatella P, Hildick-Smith D, Gaita F, Kyrle P, Thomson J, Derumeaux G, Sibbing D, Chessa M, Hornung M, Zamorano J, Dudek D. European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions. EUROINTERVENTION 2021; 17:e367-e375. [PMID: 33506796 PMCID: PMC9724983 DOI: 10.4244/eij-d-20-00785] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.
Collapse
Affiliation(s)
- Christian Pristipino
- San Filippo Neri - ASL Roma 1 Hospital, Via Alessandro Poerio 140, 00152 Rome, Italy
| | | | - Danilo Toni
- Hospital Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Horst Sievert
- CardioVascular Center Frankfurt (CVC Frankfurt), Frankfurt, Germany,Anglia Ruskin University, Chelmsford, United Kingdom,University California San Francisco (UCSF), San Francisco, CA, USA
| | | | - Fabrizio D'Ascenzo
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | - Jean-Louis Mas
- Hôpital Sainte-Anne, Université Paris Descartes, Paris, France
| | | | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Fiorenzo Gaita
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | - Dirk Sibbing
- Privatklinik Lauterbacher Mühle am Ostersee, Iffeldorf and Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Massimo Chessa
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marius Hornung
- CardioVascular Center Frankfurt (CVC Frankfurt), Frankfurt, Germany
| | | | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| |
Collapse
|
7
|
Paradoxical Platypnea-Orthodeoxia Syndrome Induced by Patent Foramen Ovale and Highly Tortuous Descending Thoracic Aorta: A Case Report. A A Pract 2021; 15:e01493. [PMID: 34166249 DOI: 10.1213/xaa.0000000000001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Perioperative hypoxemia is common in patients with aortic dissection. Platypnea-orthodeoxia syndrome (POS), in which hypoxemia in the upright position improves with relocating to a recumbent position, can be a rare cause of hypoxemia. This syndrome is more likely to occur in patients with an intracardiac shunt and aortic malformation. Hypoxemic symptoms present in our patient were paradoxical to those of common POS due to the highly tortuous descending thoracic aorta (DTA) and Eustachian valve. Therefore, establishing the diagnosis was difficult. POS should be suspected when patients with high tortuosity and curvature of DTA show hypoxemia.
Collapse
|
8
|
Pillai A, Padala SK, Ellenbogen KA, Koneru JN. An Unusual Complication of Transseptal Puncture. JACC Case Rep 2021; 3:41-46. [PMID: 34317466 PMCID: PMC8305646 DOI: 10.1016/j.jaccas.2020.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 06/01/2023]
Abstract
The interatrial septum is a structure with complex embryological development. The true atrial septum is a circumscribed structure, and transgression outside of this area during transseptal puncture may result in entry into the extracardiac space or aorta that may result in a pericardial effusion or cardiac tamponade. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Ajay Pillai
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Santosh K. Padala
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kenneth A. Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jayanthi N. Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
9
|
Beyls C, Bohbot Y, Marion B, Canaple S, Guillaumont MP, Jarry G, Fournier A, Malaquin D, Abou-Arab O, Mahjoub Y, Tribouilloy C, Leborgne L. Aortic root dilatation in PFO-related cryptogenic stroke: A propensity score-matched analysis. Echocardiography 2020; 37:883-890. [PMID: 32449845 DOI: 10.1111/echo.14711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Dilatation of the ascending aorta has an important role in the anatomical conformation of interatrial septum (IAS) especially when a patent foramen ovale (PFO) is present. The aim of the study was to investigate the relationship between ascending aortic dilation and PFO-related cryptogenic stroke in a cohort of cryptogenic strokes. METHODS It is a retrospective, single-center echocardiographic study assessing aortic root dilatation in 315 consecutive patients with cryptogenic stroke between January 2011 and January 2019. Aortic root dilatation was defined by a diameter of the Valsalva sinuses of the proximal aorta >40 mm. Predictive factors of PFO were assessed by a multivariate analysis. Propensity score matching was applied to account for clinical differences. RESULTS Of the 315 patients, 68 (22%) had an aortic root dilatation and 167 (53%) had a PFO. In the aortic root dilation group, PFO was more often diagnosed (n = 47/68 [69%], vs n = 120/247 [49%], P = .004). In the PFO group with aortic dilatation, IAS was more mobile (n = 37/47[79%] vs n = 69/120[57%], P < .012) and smaller (2.3 ± 0.5 vs 2.5 ± 0.5 mm, P < .009). On multivariate analysis, aortic root dilatation (OR: 2.6; 95% CI [1.2-5.6]; P = .001) and IAS hypermobility (OR: 5.2 95% CI [2.7-10]; P = .001) were associated with PFO. After propensity matching, aortic root dilatation remained strongly associated with PFO (n = 34/107 [32%] vs 15/107[14%], P = .002). CONCLUSION Aortic root dilation and IAS hypermobility were strongly associated with PFO-related cryptogenic stroke.
Collapse
Affiliation(s)
- Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Bourgain Marion
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Sandrine Canaple
- Department of Neurology, Amiens University Hospital, Amiens, France
| | | | - Geneviève Jarry
- Department of Intensive Cardiac Care Unit, Amiens University Hospital, Amiens, France
| | - Alexandre Fournier
- Department of Intensive Cardiac Care Unit, Amiens University Hospital, Amiens, France
| | - Dorothée Malaquin
- Department of Intensive Cardiac Care Unit, Amiens University Hospital, Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | | | - Laurent Leborgne
- Department of Intensive Cardiac Care Unit, Amiens University Hospital, Amiens, France
| |
Collapse
|
10
|
Low Z, Darvall JN, Radford ST. Platypnoea-Orthodeoxia Syndrome Post Laparoscopic Surgery in a Patient with a Patent Foramen Ovale. Anaesth Intensive Care 2019; 42:385-8. [DOI: 10.1177/0310057x1404200317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Z. Low
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Intensive Care Department, Royal Melbourne Hospital, Melbourne, Victoria
| | - J. N. Darvall
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Intensive Care Department, Royal Melbourne Hospital, Melbourne, Victoria
| | - S. T. Radford
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Intensive Care Department, Royal Melbourne Hospital, Melbourne, Victoria
| |
Collapse
|
11
|
Porter BS, Hettleman B. Treatment of Platypnea-Orthodeoxia Syndrome in a Patient with Normal Cardiac Hemodynamics: A Review of Mechanisms with Implications for Management. Methodist Debakey Cardiovasc J 2018; 14:141-146. [PMID: 29977471 DOI: 10.14797/mdcj-14-2-141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Platypnea-orthodeoxia syndrome is a rare entity characterized by dyspnea and hypoxemia in the sitting position and usually resolved by lying down. Although it is not well understood, it is thought to be associated with either intracardiac or extracardiac factors. Within the group of intracardiac etiologies, it typically occurs in the presence of right heart failure or elevated right-sided filling pressures. When right heart failure is absent, platypnea-orthodeoxia is thought to be due to either anatomic changes that produce a baffle-directing flow across an atrial defect or to posture-dependent right-to-left pressure gradients. We report this case of a patient with no prior diagnosis of heart failure who presented to our hospital with 6 months of New York Heart Association class IV dyspnea and recent paradoxical embolus across a patent foramen ovale (PFO). Platypnea-orthodeoxia syndrome was diagnosed clinically. Transesophageal echocardiography revealed bidirectional shunting across the PFO. In the catheterization laboratory, invasive hemodynamics showed normal right and left atrial pressures and normal pulmonary arterial pressures. An Amplatzer Cribiform occluder device (AGA Medical Corp.) was used to close the PFO, completely curing the patient's symptoms. This is a novel case of subacute-onset severe platypnea-orthodeoxia associated with paradoxical embolus occurring while seated in the upright position. The cause of the patient's symptoms may have been progressive kyphosis or to increased pulmonary tidal volumes. Evaluation for platypnea-orthodeoxia is important in cases of occult dyspnea because the condition may be cured by closing the anatomic defect, as it was in this case.
Collapse
|
12
|
Ghijselinck P, Van den Saffele J, Hollanders G. Cardiac platypnea-orthodeoxia syndrome induced by a low-volume state. Acta Clin Belg 2017; 72:205-209. [PMID: 27346487 DOI: 10.1080/17843286.2016.1196863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the case of a 85-year-old patient admitted with palpitations and dyspnea. When assuming a recumbent position, we noticed a significant improvement in dyspnea, as well as a rise in arterial oxygen saturation. This is a typical presentation of platypnea-orthodeoxia syndrome (POS). The diagnosis was confirmed by serial analyses of the arterial oxygen saturation in different positions. In our patient, POS was caused by a cardiac right-left shunt through a patent foramen ovale, facilitated by an atrial septal aneurysm, a dilated aortic root and a large Eustachian valve. A low-volume state, caused by diarrhea and worsened by administration of diuretics in the emergency room, triggered the POS to become clinically apparent. We also noticed a rise in arterial oxygen saturation when the patient was in a hypertensive state. This has never been described before and underlines the influence of hemodynamic changes on the right-left shunt that underlies POS.
Collapse
|
13
|
Kazawa S, Enomoto T, Suzuki N, Koshikawa T, Okubo Y, Yoshii S, Sato M, Okabe M, Yamashina A, Aizawa Y. Platypnea-orthodeoxia Syndrome in a Patient with an Atrial Septal Defect: The Diagnosis and Choice of Treatment. Intern Med 2017; 56:169-173. [PMID: 28090047 PMCID: PMC5337462 DOI: 10.2169/internalmedicine.56.7728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 77-year-old woman developed dyspnea over three years which occurred during sitting, standing or walking. Her physical examination, chest X-ray, ECG and cardiac catheterization results were all normal. A marked fall in arterial oxygen saturation was observed on sitting or standing. Transesophageal echocardiography showed an increase of right to left shunt flow on sitting. The patient was diagnosed with platypnea-orthodeoxia syndrome and underwent the surgical closure of an atrial septal defect of 19 mm in diameter. After the surgery, the patient's POS symptoms were completely resolved. She was discharged and followed at the outpatient clinic. Her post-treatment course was uneventful.
Collapse
|
14
|
Sabater Abad C, Juan Samper G, Payá Serrano R, Pérez Boscá JL, Ramón Capilla M, Fernandez Fabrellas E. Cardiac platypnea-orthodeoxia syndrome: A «mysterious» cause of hypoxemia. Arch Bronconeumol 2016; 52:494-5. [PMID: 26975978 DOI: 10.1016/j.arbres.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Cristina Sabater Abad
- Servicio de Neumología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - Gustavo Juan Samper
- Servicio de Neumología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Rafael Payá Serrano
- Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | | | - Mercedes Ramón Capilla
- Servicio de Neumología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | | |
Collapse
|
15
|
Townsend RDS, Costa ALM, Gib MC, Dexheimer Neto FL. Platypnea-orthodeoxia syndrome in patients presenting enlarged aortic root: case report and literature review. Rev Bras Ter Intensiva 2016; 26:313-6. [PMID: 25295827 PMCID: PMC4188469 DOI: 10.5935/0103-507x.20140044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/14/2014] [Indexed: 12/04/2022] Open
Abstract
We describe herein a case of a patient who, when in orthostatic positions, had severe
hypoxemia and ventilatory dysfunction. Although the severity of symptoms required
hospitalization in an intensive care setting, the initial tests only identified the
presence of enlarged aortic root, which did not explain the condition. The
association of these events with an unusual etiology, namely intracardiac shunt,
characterized the diagnosis of platypnea-orthodeoxia syndrome. The literature review
shows that, with advancing research methods, there was a progressive increase in the
identification of this condition, and this association should be part of the
differential diagnosis of dyspnea in patients with enlarged aortic root.
Collapse
Affiliation(s)
| | | | - Marcelo Cúrcio Gib
- Serviço de Cirurgia Cardiovascular, Hospital Ernesto Dornelles, Porto Alegre, RS, Brasil
| | | |
Collapse
|
16
|
Faroux L, Tassan-Mangina S, Aludaat C, Boulagnon C, Bauley K, Nazeyrollas P, Metz D. [Giant cell arteritis and unexplained hypoxemia]. Presse Med 2015; 44:1276-8. [PMID: 26585745 DOI: 10.1016/j.lpm.2015.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/08/2015] [Accepted: 09/03/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Laurent Faroux
- CHU de Reims, hôpital Robert-Debré, service de cardiologie et pathologie vasculaire, avenue du Général-Koenig, 51092 Reims cedex, France.
| | - Sophie Tassan-Mangina
- CHU de Reims, hôpital Robert-Debré, service de cardiologie et pathologie vasculaire, avenue du Général-Koenig, 51092 Reims cedex, France
| | - Chadi Aludaat
- CHU de Reims, hôpital Robert-Debré, service de chirurgie thoracique et cardiovasculaire, avenue du Général-Koenig, 51092 Reims cedex, France
| | - Camille Boulagnon
- CHU de Reims, laboratoire d'anatomie et de cytologie pathologiques, avenue du Général-Koenig, 51092 Reims cedex, France
| | - Karine Bauley
- CHU de Reims, hôpital Robert-Debré, service de cardiologie et pathologie vasculaire, avenue du Général-Koenig, 51092 Reims cedex, France
| | - Pierre Nazeyrollas
- CHU de Reims, hôpital Robert-Debré, service de cardiologie et pathologie vasculaire, avenue du Général-Koenig, 51092 Reims cedex, France
| | - Damien Metz
- CHU de Reims, hôpital Robert-Debré, service de cardiologie et pathologie vasculaire, avenue du Général-Koenig, 51092 Reims cedex, France
| |
Collapse
|
17
|
Mirzada N, Ladenvall P, Johansson MC. Absence of significant aortic regurgitation seven years after closure of patent foramen ovale. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 4:59-62. [PMID: 29450184 PMCID: PMC5801459 DOI: 10.1016/j.ijchv.2014.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/08/2014] [Accepted: 06/24/2014] [Indexed: 11/14/2022]
Abstract
Background It has been suggested that there is an increase in aortic regurgitation (AR) in the short and medium term after percutaneous closure of patent foramen ovale (PFO). The aim of this study is to determine the long-term effect of percutaneous closure of PFO on the prevalence of AR. Methods Patients with cryptogenic stroke or transient ischemic attack who had undergone percutaneous closure of PFO more than five years before the study were invited to an echocardiographic examination. Results Out of 83 invited patients, 64 accepted the invitation and were examined with echocardiography. Mild AR was found in one patient (2%), but this was already evident in the patient's echocardiographic result before PFO closure. Trace AR was detected in 11 patients (17%). No case of moderate or severe AR was detected. Patients with AR were more often hypertensive (six out of 12 patients with AR, compared to nine of the 52 without AR, p = 0.025), and the indexed sinus of Valsalva was larger in patients with AR (18.6 mm/m2, SD 1.6, as compared to 17.3 mm/m2, SD 1.6, p = 0.02). Conclusion In this long-term study with a minimum follow-up of 5.6 years and a mean of 7.1 years, we found negligible levels of AR. Where present, AR was associated with hypertension and mild dilatation of the aortic root, but there was no indication that device closure per se increased the risk of developing AR.
Collapse
Affiliation(s)
- Naqibullah Mirzada
- Institute of Medicine, Department of Molecular and Clinical Medicine, Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Per Ladenvall
- Institute of Medicine, Department of Molecular and Clinical Medicine, Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Magnus C Johansson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| |
Collapse
|
18
|
Rodrigues P, Monteiro M, Palma P, Sousa-Pereira L, Cabral S, Oliveira F, Dias V, Torres S. Body position and oxygenation: An intriguing relationship. Rev Port Cardiol 2014; 33:385.e1-5. [PMID: 25001164 DOI: 10.1016/j.repc.2014.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/01/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022] Open
Abstract
Dyspnea and hypoxemia are among the most common symptoms and signs that need to be assessed in clinical practice. This case illustrates how simple steps in history taking and physical examination can be crucial for diagnosis. We present a patient with intermittent hypoxemia, initially attributed to a pulmonary infection. However, the hypoxemia persisted even after successful treatment of the infection. Computed tomography angiography of the chest and ventilation/perfusion lung scan excluded pulmonary embolism. We then observed that the hypoxemia and dyspnea were triggered by orthostatism. An echocardiogram with a bubble test showed a patent foramen ovale, with a right-to-left shunt, without pulmonary hypertension. After percutaneous closure of the foramen ovale, the symptoms completely resolved. This is a case of platypnea-orthodeoxia syndrome, which is usually associated with patent foramen ovale or atrial septal defect and is typically observed in the elderly. The features and causes of this curious syndrome are discussed.
Collapse
Affiliation(s)
| | - Marta Monteiro
- Internal Medicine Departments, Centro Hospitalar do Porto, Porto, Portugal
| | - Paulo Palma
- Cardiology, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Sofia Cabral
- Cardiology, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Vasco Dias
- Cardiology, Centro Hospitalar do Porto, Porto, Portugal
| | - Severo Torres
- Cardiology, Centro Hospitalar do Porto, Porto, Portugal
| |
Collapse
|
19
|
Body position and oxygenation: An intriguing relationship. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
20
|
Blanche C, Noble S, Roffi M, Testuz A, Müller H, Meyer P, Bonvini JM, Bonvini RF. Platypnea-orthodeoxia syndrome in the elderly treated by percutaneous patent foramen ovale closure: a case series and literature review. Eur J Intern Med 2013; 24:813-7. [PMID: 24007641 DOI: 10.1016/j.ejim.2013.08.698] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/24/2013] [Accepted: 08/12/2013] [Indexed: 01/11/2023]
Abstract
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.
Collapse
Affiliation(s)
- Coralie Blanche
- Cardiology Division, University Hospital, Geneva, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
Patent foramen ovale (PFO) is considered a risk factor for serious clinical syndromes, the most important of which is cryptogenic stroke in the setting of paradoxic embolism. The safety and feasibility of transcatheter PFO closure have been addressed in several studies; this procedure is performed worldwide with excellent results. Variations in the atrial septal configuration and PFO are frequent and have an impact on the technical aspects and success in transcatheter PFO closure. To minimize the rate of complications of percutaneous closure of PFO, patients must be carefully selected on the basis of morphology and location of the interatrial defect.
Collapse
Affiliation(s)
- Eustaquio Onorato
- Clinica Montevergine, Via M. Malzoni, 83013 Mercogliano (Av), Italy; Humanitas Gavazzeni, Bergamo, Italy.
| | - Francesco Casilli
- Emodinamica e Radiologia Cardiovascolare, Policlinico San Donato, Piazza Edmondo Malan-20097 San Donato Milanese, Milano, Italy
| |
Collapse
|
22
|
Brugts J, Liesting C, Kofflard M, van den Bos E. Right-to-Left Atrial Shunting with Normal Intracardiac Pressures following Cardiac Surgery: Pathophysiology and Management. J Card Surg 2012; 27:335-337. [DOI: 10.1111/j.1540-8191.2011.01362.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
23
|
Floria M, Gabriel L, Schroeder E, Chenu P, Ambăruş V, Marchandise B. Stroke and an unexplained dyspnea in an elderly patient: Platypnea-orthodeoxia syndrome. Geriatr Gerontol Int 2012; 12:356-8. [DOI: 10.1111/j.1447-0594.2011.00758.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Keenan NG, Brochet É, Juliard JM, Malanca M, Aubry P, Lepage L, Cueff C, Jondeau G, Iung B, Vahanian A, Messika-Zeitoun D. Aortic root dilatation in young patients with cryptogenic stroke and patent foramen ovale. Arch Cardiovasc Dis 2012; 105:13-7. [DOI: 10.1016/j.acvd.2011.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 11/10/2011] [Accepted: 11/15/2011] [Indexed: 02/07/2023]
|
25
|
Rodrigues P, Palma P, Sousa-Pereira L. Platypnea-Orthodeoxia Syndrome in Review: Defining a New Disease? Cardiology 2012; 123:15-23. [DOI: 10.1159/000339872] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 05/23/2012] [Indexed: 11/19/2022]
|
26
|
Schwarz K, Du Rand I, Austin S, Routledge H. Intermittent cardiac shunt mimicking pulmonary embolism and COPD. QJM 2010; 103:523-5. [PMID: 20047931 DOI: 10.1093/qjmed/hcp189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Schwarz
- Cardiology Department, Worcestershire Royal Hospital, Charles Hastings Way, Worcester, Worcestershire WR5 1DD, UK.
| | | | | | | |
Collapse
|
27
|
Angelini M, Lambru G, Montepietra S, Riccardi M, Zanferrari C, Bortone E. Unexplained dyspnea in an old patient with recurrent stroke: platypnea–orthodeoxia syndrome and evidence of patent foramen ovale. Neurol Sci 2009; 31:93-4. [DOI: 10.1007/s10072-009-0169-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022]
|