scholarly journals P248 Changes of atrial septum defect caused by posture during three-dimensional transesophageal echocardiography ( a case of Platypnea-orthodeoxia syndrome)

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Y Takeuchi ◽  
S Suzuki ◽  
H Tsuneyoshi ◽  
H Sakamoto ◽  
T Shimada
Keyword(s):  
Blood Flow ◽  
Transesophageal Echocardiography ◽  
Supine Position ◽  
Three Dimensional ◽  
Atrial Septum ◽  
Arterial Oxygen ◽  
Sitting Position ◽  
Postural Change ◽  
Right Heart ◽  
Shunt Flow

Abstract Background Platypnea-Orthodeoxia syndrome (POS) is a rare phenomenon which is characterized postural hypoxia due to the intracardiac shunt from right to left through a patent foramen ovale, an atrial septal defect or a pulmonary arteriovenous malformation. POS is often underestimated because the hypoxia by postural change is difficult to be detected. We evaluated three-dimensional transesophageal echocardiography (TEE) to diagnose POS in an elderly patient. Case report A 84-year-old woman suffered from repetitive syncope for several years. She undertook twelve leads electrocardiogram (ECG), screening transthoracic echocardiography (TTE), twenty-four hours ECG and treadmill stress ECG, however, the cause of syncope was not identified. After another syncope event happened, she was transferred to the emergency room. Then, the hypoxia caused by sitting position was pointed out for the first time. Her hypoxia was improved by supine position and oxygen administration. TTE demonstrated no right heart enlargement. Shunt flow was suspected on her atrial septum; however, it was difficult to reveal it by TTE because of her obesity. Therefore, she underwent intravenous saline injection test. In the decubitus position, an intravenous injection of saline under Valsalva maneuver revealed the shunt flow from the right atrium to the left atrium. Her arterial oxygen saturation (SpO2) was 95%. In the sitting position, a visible shunt flow was observed, then her SpO2 dropped to 85%. By TEE, the shunt hole was found in the oval fossa of the atrial septum. TEE was evaluated by different positions. The atrial defect hole became larger in the sitting position (area 1.05cm2) than in the supine position (area 0.43cm2). As a result, the postural change to sitting revealed Platypnea-Orthodeoxia syndrome associated with ASD. The pulmonary blood flow/systemic blood flow ratio (Qp/Qs) was estimated at 1.6. After surgical ASD closure, she was discharged without any symptoms. Conclusion Unclearness of TTE and the absence of a right heart overload may lead to misdiagnosis of POS. If a syncope patient caused hypoxia in the only sitting position, detailed echocardiography should be needed to rule out a diagnosis of POS. This is considerably valuable case of three-dimensional TEE confirmed the changes of ASD size by postural change. Abstract P248 Figure.

Two- and Three-Dimensional Transesophageal Echocardiography for Two Separate Primary Cardiac Lymphomas in the Right Heart

2017 ◽  
Vol 125 (1) ◽  
pp. 44-47
Author(s):  
Masataka Kuroda ◽  
Takashi Sakamoto ◽  
Masaki Orihara ◽  
Shigeru Saito
Keyword(s):  
Transesophageal Echocardiography ◽  
Three Dimensional ◽  
Right Heart ◽  
The Right

Optimum Position for an Antisiphon Device in a Cerebrospinal Fluid Shunt System

Neurosurgery ◽  
1991 ◽  
Vol 29 (4) ◽  
pp. 519-525 ◽  
Author(s):  
Kazuhiko Tokoro ◽  
Yasuhiro Chiba
Keyword(s):  
Supine Position ◽  
Normal Pressure ◽  
Low Pressure ◽  
Sitting Position ◽  
Foramen Of Monro ◽  
Shunt System ◽  
Shunt Valve ◽  
Shunt Flow ◽  
Optimum Position ◽  
Antisiphon Device

Abstract The effects on shunt flow from the position of an antisiphon device (ASD) and from changes in posture in hydrocephalic patients were examined. Fifty patients with hydrocephalus (including 36 with normal pressure hydrocephalus) were investigated, using quantitative radionuclide shuntography (99mtechnetium-pertcchnetate) in the supine, sitting, and standing positions. The types of shunt valve used were as follows: Mishler dual chamber low pressure without ASD (16 cases), with ASD 40 cm below the level of the foramen of Monro (three cases), and with ASD 10 cm below the level of the foramen of Monro (12 cases); low pressure with integral ASD (14 cases); and medium pressure with integral ASD (five cases). In patients with a low pressure valve without ASD, shunt flow was least in the supine position (0.0011 ml/min) but increased significantly in the sitting position (0.4381 ml/min, P < 0.001) because of the siphon effect. Conversely, in patients with a low pressure valve with integral ASD, shunt flow was maximal in the supine position (0.1056 ml/min) and decreased significantly in the sitting position (0.0017 ml/min, P < 0.001), indicating overfunction of the ASD. Intracranial pressure (ICP) in the supine position increased significantly compared with patients with a low pressure valve without ASD (93.6 and 20.7 mm H2O. respectively, P < 0.01). Intermediate values for shunt flow in the supine and sitting positions (0.0279 and 0.0896 ml/min, respectively) and for ICP (55.8 mm H2O) were obtained with patients with a low pressure valve with the ASD 10 cm below the level of the foramen of Monro P < 0.05). Shunt flow in the supine position correlated negatively with the log of the shunt flow in the sitting position (P < 0.025). Shunt flow in the sitting position correlated positively with the distance between the ASD and the level of the foramen of Monro (P < 0.01). ICP in the supine position correlated negatively with the distance between the ASD and the level of the foramen of Monro (P < 0.025). Shunt flow and ICP are significantly affected by the position of the ASD and the patient's posture. The optimum position for the ASD appears to be 10 cm downstream; the resulting hydrostatic column helps initiate flow when the patient assumes the sitting and standing positions.

scholarly journals STUDIES ON THE CIRCULATION IN MAN

1913 ◽  
Vol 18 (4) ◽  
pp. 354-371 ◽  
Author(s):  
G. N. Stewart
Keyword(s):  
Blood Flow ◽  
Supine Position ◽  
Sitting Position

1. The blood flow in the feet is smaller per unit of volume of the part than in the hand, the ratio of foot flow to hand flow per 100 cubic centimeters of the part usually lying in normal persons between 1 to 3 and 1 to 2. 2. In the supine position, with the legs hanging down, the flow in the feet seems to be somewhat greater than in the sitting position.

scholarly journals Three-dimensional alignment changes of the shoulder girdle between the supine and standing positions

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Noboru Matsumura ◽  
Yoshitake Yamada ◽  
Satoshi Oki ◽  
Yuki Yoshida ◽  
Yoichi Yokoyama ◽  
...  
Keyword(s):  
Supine Position ◽  
Daily Activity ◽  
Three Dimensional ◽  
Shoulder Girdle ◽  
Standing Position ◽  
Ct Scans ◽  
Sitting Position ◽  
Coordinate Systems ◽  
3 Dimensional ◽  
Bony Landmarks

Abstract Background Although humans spend most of their day in a standing or sitting position, it is difficult to accurately evaluate the alignment of the shoulder girdle during daily activity, and its alignment changes between positions. The purpose of this study was to evaluate the 3-dimensional alignment of the shoulder girdle in the supine and standing positions by computed tomography (CT) and to assess the alignment changes of the shoulder girdle between these two positions. Methods CT scans of both shoulders of 100 healthy volunteers were prospectively taken in both supine and standing positions on the same day. The local 3-dimensional coordinate systems of the thorax, clavicle, and scapula were defined from the specific bony landmarks, and 3-dimensional angular rotations and positions of the clavicle and scapula were calculated. Differences in rotations and positions of the clavicle and scapula were evaluated between the supine and standing positions. Results Compared with the supine position, the clavicle showed significantly less elevation and greater retraction, and the scapula showed significantly less upward rotation, anterior tilting, and internal rotation in the standing position. Compared with the supine position, the clavicle center was located more inferiorly, posteriorly, and laterally, and the scapula center was located more inferiorly, posteriorly, and medially in the standing position. Conclusions The present study showed that angular rotations and positions of the clavicle and scapula change significantly with position due to the effect of gravity.

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