scholarly journals Patent foramen ovale presenting with platypnoea-orthodeoxia syndrome and stroke after multi-organ resection

2021 ◽  
Vol 14 (2) ◽  
pp. e236784
Author(s):  
Khaled Elenizi ◽  
Rasha Alharthi
Keyword(s):  
Patent Foramen Ovale ◽  
Oxygen Therapy ◽  
Ovarian Cancer Patient ◽  
Transoesophageal Echocardiography ◽  
Positive Outcome ◽  
Upright Position ◽  
Pelvic Surgery ◽  
Foramen Ovale ◽  
Therapeutic Modalities ◽  
Lying Down

Platypnoea-orthodeoxia syndrome (POS) is defined by oxygen desaturation and dyspnoea in upright position that improves by lying down. It results from a right to left shunt at the intracardiac or intrapulmonary level. A 53-year-old ovarian cancer patient presented with POS that was refractory to oxygen therapy. The symptoms began after an extensive abdominal and pelvic surgery as treatment of her cancer with a complex hospital course. A patent foramen ovale was found with the use of transoesophageal echocardiography. A percutaneous closure was done with positive outcome and dyspnoea disappearance. In this case with its challenging clinical setting, we present a unique clinical scenario of an immediate postoperative POS syndrome. We address the different therapeutic modalities and the need for a multidisciplinary medical approach.

scholarly journals Platypnea–orthodeoxia syndrome associated with COVID-19 pneumonia: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takuo Hoshi ◽  
Yu Tadokoro ◽  
Masaru Nemoto ◽  
Junya Honda ◽  
Shihori Matsukura
Keyword(s):  
Case Report ◽  
Patent Foramen Ovale ◽  
Oxygen Therapy ◽  
Upright Position ◽  
Sitting Position ◽  
Foramen Ovale ◽  
Recumbent Position ◽  
Gradual Improvement ◽  
Case Presentation ◽  
Intracardiac Shunt

Abstract Background Platypnea–orthodeoxia syndrome (POS) is a rare clinical condition characterized by respiratory distress and/or hypoxia developing in the sitting/upright position, which is relieved in the recumbent position. This syndrome is known to have an intracardiac shunt as its primary etiology. Here, we report the case of a patient who was found to have POS without an intracardiac shunt while recovering from coronavirus disease (COVID-19) pneumonia. Case presentation A 73-year-old woman was diagnosed with severe COVID-19 pneumonia and was managed according to our institutional protocol. Although her oxygenation improved at rest, oxygen saturation dropped to lower than 80% when she was in the sitting position. She had no patent foramen ovale or other intracardiac shunts. She showed gradual improvement and was discharged under home oxygen therapy 28 days after admission. Conclusions This report highlights the importance of continuous bedside monitoring of pulse oximetry during positional changes, even if it is stable at rest, in patients with moderate to severe COVID-19.

Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt following pneumonectomy

2021 ◽  
Vol 14 (10) ◽  
pp. e245699
Author(s):  
Matthew Steward ◽  
Anthony Hall ◽  
Ross Sayers ◽  
Christopher Dickson
Keyword(s):  
Patent Foramen Ovale ◽  
Transoesophageal Echocardiography ◽  
Foramen Ovale ◽  
Success Rates ◽  
Interatrial Communication ◽  
Population Prevalence ◽  
Contrast Enhanced ◽  
High Index Of Suspicion ◽  
Interatrial Shunt

A 62-year-old man presents with breathlessness 6 months following right pneumonectomy for lung adenocarcinoma. Previous investigations had not yielded a diagnosis and his symptoms were progressing. The patient described worsened symptoms when stood up (platypnoea), with profound hypoxia until laid supine (orthodeoxia). Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt was diagnosed on contrast-enhanced transoesophageal echocardiography with the patient undergoing successful percutaneous patent foramen ovale closure. Patent foramen ovale is often asymptomatic with a population prevalence of around 20%–30%. Anatomical shifts postpneumonectomy can open, or worsen a previously closed interatrial communication leading to right-to-left shunting of blood. Platypnoea-orthodeoxia is under-recognised, impairing quality of life and patient outcome. Investigations can be falsely reassuring, or poorly sensitive for the causative pathology. Percutaneous closure is safe with high success rates and this case highlights the need for a high index of suspicion for shunts, particularly in postpneumonectomy patients.

Platypnoea-orthodeoxia syndrome in the elderly: A difficult-to-make diagnosis of intracardiac right-to-left shunt

2017 ◽  
Vol 62 (3) ◽  
pp. 122-125 ◽  
Author(s):  
Enrico M Zardi ◽  
Silvia Spoto ◽  
Luciana Locorriere ◽  
Giulio Cacioli ◽  
Silvia Mazzaroppi ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Arteriovenous Malformations ◽  
Clinical Signs ◽  
Vascular Complications ◽  
The Elderly ◽  
Upright Position ◽  
Foramen Ovale ◽  
Case Presentation ◽  
Hepatic Diseases ◽  
Chronic Pulmonary Diseases

Introduction Platypnea-orthodeoxia syndrome is a combination of positional dyspnoea and hypoxemia; it is caused by several cardiac, pulmonary and hepatic diseases. Case presentation In this study, we describe a 77-year-old female affected by unexplained dizziness and hypoxia that exacerbated in upright position. After diagnosing platypnea-orthodeoxia syndrome and excluding all possible causes (liver cirrhosis, acute and chronic pulmonary diseases and arteriovenous malformations), the origin of the syndrome was individuated in the presence of a patent foramen ovale with right-to-left shunt. Endovascular patent foramen ovale closure permitted the resolution of symptoms and disappearance of platypnea-orthodeoxia syndrome. Conclusion Although patent foramen ovale may be present since birth without giving clinical signs, it may represent a common enough cause of platypnea-orthodeoxia syndrome and other vascular complications in the elderly.

Abstract 4687: Prospective Comparison of Intracardiac Versus Transoesophageal Echocardiography Guided Closure of Patent Foramen Ovale and Atrial Septal Defects in Adults - Five Year Single Centre Experience

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kaleab N Asrress ◽  
Ryan G Schrale ◽  
Kulveer S Mankia ◽  
Sayed A Raza ◽  
Chandra Puli ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Success Rate ◽  
General Anaesthesia ◽  
Patent Foramen Ovale ◽  
Transoesophageal Echocardiography ◽  
Inpatient Stay ◽  
Foramen Ovale ◽  
Interatrial Communication ◽  
Device Deployment ◽  
Asd Closure

Imaging to guide percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) has traditionally required transoesophageal echocardiography (TOE) with general anaesthesia. The development of intracardiac echocardiography (ICE) allows these procedures to be performed under local anaesthesia, obviating the need for endotracheal intubation and general anaesthesia. We set out to prospectively evaluate the effect of ICE on the success and efficiency of PFO and ASD closure. Data on all adult patients undergoing percutaneous PFO and ASD closure were collected prospectively between 2003 and 2008. Allocation to echocardiographic technique was non-random and determined by availability of anaesthetic and cardiology staff, initial ICE probe availability and relative contraindication to general anaesthesia. Procedure time, fluoroscopy time, radiation dose, device deployment success rate, procedural complications, hospital stay length, and interatrial communication closure at 3 months were compared between the two imaging modalities. 210 consecutive patients underwent percutaneous interatrial defect closure over the study period, 55 (26%) with TOE and 155 (74%) using ICE. Baseline characteristics of the TOE and ICE groups were similar (age 45.3±15.5 vs 47.9±13.6 years, p =0.415; male 36% vs 42%, p =0.524; body surface area 1.81±0.27 vs 1.90±0.26 m 2 , p =0.110; interatrial defect size (for ASD) 19.8±8.9 vs 18.2±7.9 mm, p =0.458). Procedural time (not including induction and recovery from general anaesthesia; 50±21 vs 42±18 minutes, p =0.007), fluoroscopy time (8.0±6.0 vs 5.4±4.0 minutes, p <0.0001), radiation dose (1350±1626 vs 714±1017 cGy/cm 2 , p <0.0001), and inpatient stay 1.8±0.9 vs 1.0±3.3 days, p <0.0001) were significantly reduced using ICE. There were no differences in the device deployment success rate (94% vs 95%, p <0.724) and interatrial communication closure at 3 months (96% vs 93%, p =0.722). During percutaneous closure of interatrial defects, ICE avoids the risks and inconvenience of general anaesthesia and is associated with significantly reduced procedure times, radiation doses, and inpatient stay compared to TOE, without compromising procedure success.

scholarly journals Undiagnosed Patent Foramen Ovale Presenting as Retinal Artery Occlusion—An Emerging Association

2009 ◽  
Vol 2009 ◽  
pp. 1-2 ◽  
Author(s):  
Hiten G. Sheth ◽  
Tania Laverde-Konig ◽  
Jyoti Raina
Keyword(s):  
Patent Foramen Ovale ◽  
Transoesophageal Echocardiography ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Sudden Onset ◽  
Healthcare Personnel ◽  
Foramen Ovale ◽  
Management Options ◽  
Retinal Artery ◽  
Fundus Photographs

Purpose. To report patent foramen ovale (PFO) as the cause of retinal artery occlusion in a young and previously fit male and discuss the appropriate medical and surgical management options.Methods. Interventional case report with serial fundus photographs of an 18-year-old male presenting to the eye casualty with sudden onset left visual loss.Results. Visual acuities were 6/24 left and 6/4 right with a left afferent pupillary defect. Slitlamp examination confirmed a left hemiretinal artery occlusion and subsequent cardiology review with transoesophageal echocardiography revealed patent foramen ovale which was closed surgically.Conclusions. PFO is not uncommon and is often covert but predisposes individuals to embolic events. These events may be ophthalmic with visual sequelae and so ophthalmologists, physicians, and other healthcare personnel should be aware of this important and emerging association.

Platypnea-Orthodeoxia

2010 ◽  
pp. 192-198
Author(s):  
Edward C. Rosenow
Keyword(s):  
Blood Flow ◽  
Inferior Vena Cava ◽  
Pulmonary Embolus ◽  
Patent Foramen Ovale ◽  
Vena Cava ◽  
Upright Position ◽  
Horizontal Position ◽  
Foramen Ovale ◽  
Right Heart ◽  
Predisposing Factor

• Platypnea: dyspnea in upright position • Orthodeoxia: hypoxemia in upright position • Both conditions occur with normal right heart pressures • Right pneumonectomy is most common predisposing factor • Pulmonary embolus is next most common predisposing factor • Theory: after right pneumonectomy, gradual rotation of heart toward the horizontal position and torsion when patient is in the upright position open a patent foramen ovale (PFO). Blood flow from the inferior vena cava goes directly to and through the PFO...

Right bundle branch block as a marker for interatrial septal abnormalities

2011 ◽  
Vol 22 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Aurora Bakalli ◽  
Dardan Koçinaj ◽  
Ljubica Georgievska-Ismail ◽  
Tefik Bekteshi ◽  
Ejup Pllana ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Right Bundle Branch Block ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Transoesophageal Echocardiography ◽  
Adult Patients ◽  
P Value ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Bundle Branch Block

AbstractBackgroundInteratrial septal anomalies, which include atrial septal defect, patent foramen ovale, and atrial septal aneurysm, are common disorders among adult patients. Early detection of interatrial septal anomalies is important in order to prevent haemodynamic consequences and/or thromboembolic events. Electrocardiogram offers some clues that should serve as hints for detection of interatrial abnormalities. The aim of our study was to analyse the interatrial septum by transoesophageal echocardiography in patients with electrocardiogram signs of right bundle branch block and in those without right bundle branch block.Methods and resultsIn a prospective study, 87 adult patients were included, that is, 41 with electrocardiogram signs of right bundle branch block forming the first group and 46 without right bundle branch block forming the second group. Interatrial septal anomalies were present in 80.5% of the patients with right bundle branch block, with patent foramen ovale (39.02%) being the most prevalent disorder, followed by atrial septal aneurysm (21.9%) and atrial septal defect (19.5%). Interatrial septal abnormalities were significantly more frequent in the first group compared with the second group (80.5% versus 6.5%, p value less than 0.001). Independently, patent foramen ovale was significantly more prevalent in patients with right bundle branch block (39.02% versus 4.3%, p value less than 0.001), as were atrial septal aneurysm (21.9% versus 2.2%, p value equal 0.01) and atrial septal defect (19.5% versus 0%, p value equal 0.004).ConclusionsRight bundle branch block should serve as a valuable indicator to motivate a detailed search for interatrial septal abnormalities.

scholarly journals Cardiovascular computed tomography versus transoesophageal echocardiography after cryptogenic ischaemic stroke – a pilot study of 12 patients

2018 ◽  
Vol 48 (1) ◽  
pp. 030006051876422
Author(s):  
Mette Sørensen Resen ◽  
Mai Bang Poulsen ◽  
Karsten Overgaard ◽  
Rune Skovgaard Rasmussen ◽  
Anne Merete Boas Soja ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pilot Study ◽  
Ischaemic Stroke ◽  
Ct Angiography ◽  
Patent Foramen Ovale ◽  
Transoesophageal Echocardiography ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Cerebral Ct Angiography ◽  
Cardiovascular Ct

Objective Transoesophageal echocardiography (TEE) is the gold standard for the detection of cardiac emboli sources in ischaemic stroke patients, but new computed tomography (CT) scanners are able to visualize the heart. This pilot study aimed to compare findings on TEE with combined cardiovascular scan and cerebral CT angiography in cryptogenic ischaemic stroke patients. Methods This pilot study enrolled patients with cryptogenic ischaemic stroke who underwent a combined cardiovascular and cerebral CT angiography scan and a TEE examination, which were interpreted in a blinded manner. Results Twelve patients with cryptogenic ischaemic stroke were included (mean age 56 years). Of these, 10 patients underwent both a combined cardiovascular and cerebral CT angiography and a TEE examination. All cardiovascular CT scans were readable at sinus rhythm. None of the simultaneous cerebral angiograms were compromised. Thrombi were not detected in any patients. Patent foramen ovale was visualized in five patients by TEE, while cardiovascular CT only identified three. Cardiovascular CT revealed in addition an X-ray negative pulmonary metastasis in one patient, aortic coarctation in another and significant coronary stenosis in four patients. Conclusion The sensitivity for detecting patent foramen ovale was considerably lower for cardiovascular CT than for TEE, however the cardiovascular CT revealed several other very important clinical findings.

scholarly journals Platypnoea-Orthodeoxia Syndrome: An Intriguing Diagnosis

2019 ◽  
Author(s):  
Vânia Rodrigues ◽  
Tiago Gomes ◽  
Adriana Santos Silva ◽  
Rita Rocha ◽  
Ana Ferrão
Keyword(s):  
Patent Foramen Ovale ◽  
Pulmonary Infection ◽  
Septal Defect ◽  
Symptom Relief ◽  
Upright Position ◽  
Foramen Ovale ◽  
Thoracic Ct ◽  
Ct Angiogram ◽  
Bubble Test ◽  
Lung Scan

Platypnoea-orthodeoxia syndrome (POS) is an uncommon clinical entity characterized by dyspnoea and hypoxaemia induced by upright posture and relieved by recumbence. It is often associated with right-to-left shunting through a patent foramen ovale (PFO) or an atrial septal defect. We report the case of a 79-year-old woman with hypoxaemia initially attributed to a pulmonary infection but persisting after successful treatment. Being in the upright position triggered the hypoxaemia. A thoracic CT angiogram and ventilation/perfusion lung scan excluded a pulmonary embolism, but a transoesophageal echocardiogram with a bubble test showed a PFO with a right-to-left shunt, without pulmonary hypertension. The patient underwent percutaneous closure of the PFO which led to prompt symptom relief and full functional recovery.

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