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

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.

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

Scottish Medical Journal ◽

10.1177/0036933017727430 ◽

2017 ◽

Vol 62 (3) ◽

pp. 122-125 ◽

Cited By ~ 3

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.

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Platypnea-orthodeoxia syndrome after open prostatectomy and cystolithotomy: Coincidence or unknown pathophysiology?

SAGE Open Medical Case Reports ◽

10.1177/2050313x20904592 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2090459

Author(s):

Ismael P Flores ◽

Alexandre T Maciel

Keyword(s):

Case Report ◽

Patent Foramen Ovale ◽

Inferior Vena ◽

Vena Cava ◽

Sitting Position ◽

Foramen Ovale ◽

Open Prostatectomy ◽

Anatomical Changes ◽

Upper Abdominal ◽

Cardiac Shunt

A few cases of platypnea-orthodeoxia syndrome have been described in the literature, some of them after thoracic or upper abdominal surgeries. In most cases, hypoxemia in the upright or sitting position, which is the main clinical symptom for this uncommon diagnosis, is usually related to a dynamic right to left cardiac shunt induced by anatomical changes in the relative position between the inferior vena cava and the atria in the presence of a patent foramen ovale. In this case report, we describe a situation in which platypnea-orthodeoxia syndrome developed acutely before surgery but that became severely exacerbated after an open urologic surgery without a clear acute anatomical change that could be responsible for triggering the syndrome. This case might suggest that the pathophysiology of acute platypnea-orthodeoxia syndrome is not completely elucidated and that other possible triggers for acute clinical manifestation in addition to acute anatomical thoracic changes must be explored.

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

BMJ Case Reports ◽

10.1136/bcr-2020-236784 ◽

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.

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Patent foramen ovale revealed by COVID-19 pneumonia

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01494-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Charlotte Vanhomwegen ◽

Olivier Taton ◽

Nicolas Selvais ◽

Olivier Vanhove ◽

Dimitri Leduc

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Patent Foramen Ovale ◽

Pulmonary Ventilation ◽

Rare Condition ◽

Upright Position ◽

Foramen Ovale ◽

Intrapulmonary Shunt ◽

Case Presentation ◽

Refractory Hypoxemia ◽

Interatrial Shunt

Abstract Background Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnoea (platypnea) and arterial desaturation in the upright position resolved in the supine position (orthodeoxia). Intracardiac shunt, pulmonary ventilation–perfusion mismatch and others intrapulmonary abnormalities are involved. Case presentation We report a case of POS associated with two pathophysiological issues: one, cardiac POS caused by a patent foramen ovale (PFO) and second, pulmonary POS due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interstitial pneumonia. POS has resolved after recovery of coronavirus disease 2019 (COVID-19) pneumonia. Conclusions Right-to-left interatrial shunt and intrapulmonary shunt caused by SARS-CoV-2 pneumonia contributed to refractory hypoxemia and POS. Therefore, in case of COVID-19 patient with unexplained POS, the existence of PFO must be investigated.

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