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Verdoia M, Viola O, Marenna B, Marrara F, Bertola B, Brancati MF, Gioscia R, Soldà PL, Rognoni A. Managing Congenital Heart Defects in Elderly: The Platypnea-Orthodeoxia Syndrome in Underestimated Patent Foramen Ovale. Angiology 2023:33197231199229. [PMID: 37651548 DOI: 10.1177/00033197231199229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The platypnea-orthodeoxia syndrome (POS) is a rare and often suboptimally managed condition with a complex diagnostic workup, conversely displaying an easy treatment and a good recovery of symptoms, especially if consequent to an intracardiac shunt. However, its identification is challenging, due to the several clinical manifestations, the multiple etiologies, representing often the delayed presentation of a congenital heart disease. We present a case report and review of available literature on patients with the POS secondary to a patent foramen ovale successfully treated with its closure.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Biella, Italy
- Università Del Piemonte Orientale, Novara, Italy
| | - Orazio Viola
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Biella, Italy
| | - Biondino Marenna
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Biella, Italy
| | - Federica Marrara
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Biella, Italy
| | - Benedetta Bertola
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Biella, Italy
| | | | - Rocco Gioscia
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Biella, Italy
| | - Pier Luigi Soldà
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Biella, Italy
| | - Andrea Rognoni
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Biella, Italy
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Wang X, Liu X, Zheng L, Liu Y, Guan Z, Dai J, Chen X. Correlation between percutaneous patent foramen ovale closure and recurrence of unexplained syncope. Front Neurol 2023; 14:1104621. [PMID: 36816564 PMCID: PMC9928853 DOI: 10.3389/fneur.2023.1104621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023] Open
Abstract
Background The relationship between patent foramen ovale (PFO) and unexplained syncope remains to be illustrated. Therefore, this study aimed to explore the outcomes and prognostic factors for syncope recurrence after PFO closure. Methods Patients with both large right-to-left shunting (RLS) PFO and unexplained syncope who visited the cardiovascular department of Xiangya Hospital Central South University from 1 January 2017 to 31 December 2021 were consecutively enrolled in our study. The recurrence rate of syncope was compared between the non-closure group (n = 20) and the closure group (n = 91). Results A total of 111 patients were finally included. After 31.11 ± 14.30 months of follow-up, only 11% of patients in the closure group had recurrent syncope, which was much lower than that of the non-closure group (11.0 vs. 35%, P = 0.018). We further investigated the possible prognostic factors for syncope recurrence in the closure group and found syncope occurring more than five times preoperatively, hypertension, and residual RLS at 12-month follow-up were significantly correlated with a higher number of recurrences. Conclusions PFO closure reduced the recurrence rate of unexplained syncope. The efficacy of prevention was prognosticated by factors including the presence or absence of syncope induction, the frequency of syncope episodes, and the presence or absence of hypertension. Syncope recurrence was also related to residual shunts post closure.
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Affiliation(s)
- Xianwen Wang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiangwei Liu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lulu Zheng
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yubo Liu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhengyan Guan
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jingyi Dai
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaobin Chen
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China,*Correspondence: Xiaobin Chen ✉
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It All Depends: A Case of a Position-Dependent Intracardiac Shunt. Am J Med 2022; 135:1443-1446. [PMID: 35882284 DOI: 10.1016/j.amjmed.2022.07.008] [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: 06/30/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022]
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Punzengruber G, Kolb R, Meier B, Binder RK. Percutaneous closure of a patent foramen ovale causing exercise hypoxemia: Case report and a review of the literature. Catheter Cardiovasc Interv 2021; 98:733-737. [PMID: 34145952 DOI: 10.1002/ccd.29825] [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] [Received: 12/03/2020] [Revised: 05/13/2021] [Accepted: 06/05/2021] [Indexed: 11/11/2022]
Abstract
Provoked exercise desaturation is a rare presentation of patent foramen ovale (PFO), when vigorous exercise leads to desaturation of arterial blood and subsequent dyspnea. We present a case of provoked exercise desaturation and curative percutaneous closure and review the literature. A 54-year-old male patient presented with shortness of breath during exercise in the pneumology outpatient department. During exercise spirometry, a relevant drop in arterial oxygen saturation and partial pressure of oxygen was observed and a right-left shunt suspected. In a transesophageal echocardiogram, a PFO was observed. Cardiac catheterization documented a right-left-shunt causing desaturation during exercise. Following percutaneous closure of the PFO, exercise induced desaturation was no longer detectable during exercise spirometry and there was considerable improvement in exercise capacity and subjective dyspnea. To sum up, provoked exercise desaturation is a rare but curable presentation of PFO. Percutaneous closure is a safe and effective way to treat this entity.
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Affiliation(s)
- Georg Punzengruber
- Department of Cardiology and Intensive Care, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Rainer Kolb
- Department of Pneumology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Bernhard Meier
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels-Grieskirchen, Wels, Austria
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Nema R, Rajanna C, Ray A, Jadon RS, Vikram NK. When sitting suffocates: a rare cause of platypnoea-orthodeoxia syndrome. Breathe (Sheff) 2021; 16:200205. [PMID: 33664834 PMCID: PMC7910018 DOI: 10.1183/20734735.0205-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Platypnoea-orthodeoxia syndrome refers to shortness of breath and oxygen desaturation in an upright position. Ventilation/perfusion mismatch is a rare cause of the same. Herein, we report a case of bilateral lower lobe tuberculosis, causing platypnoea and orthodeoxia. https://bit.ly/3jhJEQ1.
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Affiliation(s)
- Rahul Nema
- Dept of Medicine, AIIMS New Delhi, New Delhi, India
| | | | - Animesh Ray
- Dept of Medicine, AIIMS New Delhi, New Delhi, India
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Dvoretskiy LI, Rezvan VV. [Platypnea: оne more type position shortness of breath]. TERAPEVT ARKH 2020; 92:92-97. [PMID: 32598799 DOI: 10.26442/00403660.2020.03.000436] [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: 04/26/2020] [Indexed: 11/22/2022]
Abstract
The article presents modern data on the causes of platypnea, methods of its diagnosis and treatment. The data on the development of platypnea syndrome are given not only in cardiac pathology, but also in severe liver diseases with the development of hepatopulmonary syndrome and chronic obstructive pulmonary disease of a severe course.
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Affiliation(s)
- L I Dvoretskiy
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Rezvan
- Sechenov First Moscow State Medical University (Sechenov University)
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Agdamag AC, Gomez JM, Collado FM, Kavinsky C. Patent foramen ovale and ascending aortic aneurysm causing the platypnea-orthodeoxia syndrome. Proc (Bayl Univ Med Cent) 2019; 32:242-244. [PMID: 31191140 DOI: 10.1080/08998280.2018.1559387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022] Open
Abstract
Patent foramen ovale (PFO) is present in about 25% of the population. Platypnea-orthodeoxia syndrome (POS), which is dyspnea and hypoxemia in the upright position that is relieved when supine, is a rare manifestation of PFO. We describe a case of a 74-year-old woman who presented with new-onset hypoxia. A PFO and a dilated aorta causing POS were found on workup. Symptoms were resolved after undergoing percutaneous PFO closure. This case highlights the mechanism by which an ascending aortic aneurysm can alter hemodynamics through an existing PFO, leading to symptoms of a previously clinically insignificant PFO, and emphasizes how early recognition of POS allows for appropriate intervention.
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Affiliation(s)
| | | | - Fareed Moses Collado
- Division of Cardiology, Department of Internal Medicine, Rush University Medical CenterChicagoIllinois
| | - Clifford Kavinsky
- Division of Cardiology, Department of Internal Medicine, Rush University Medical CenterChicagoIllinois
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González-Bartol E, Rojas-González A, Díez-Villanueva P, Acosta-Gutiérrez C, Pozo-Osinalde E, Alfonso F. [Platypnea-orthodeoxia syndrome secondary to intracardiac shunt: Orientation issue?]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:357-359. [PMID: 28126374 DOI: 10.1016/j.acmx.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | | | | | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, España
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