Chest
EditorialsAn Analysis of Platypnea-Orthodeoxia Syndrome Including a “New” Therapeutic Approach
Section snippets
History
The original description of patients with platypnea-orthodeoxia dates back to 1949 when Burchell et al2 described a patient with an atrial septal defect manifesting platypnea-orthodeoxia and subsequently described the reversal of both following closure of a patent foramen ovale. “Platypnea” and “orthodeoxia” were not used to describe the manifestations of this syndrome until they became commonly accepted in 1969 and 1976, respectively.
In 1956, two patients with upright dyspnea and oxygen
Clinical Features
Table 1 outlines the etiologic background of the platypnea-orthodeoxia syndrome. It is not surprising that interatrial communications are the most common etiologic association. The population at risk is huge. Approximately 25% of the general population have a patent foramen ovale.7 Platypnea-orthodeoxia may theoretically occur with other sites of intracardiac right-to-left shunting, but this occurrence has not been documented thus far.
There are no data which can be used to estimate the
Physiologic Features
The precise mechanisms for both platypnea and orthodeoxia are unknown. In the several isolated case reports, speculation over mechanisms is often geared to whatever special features were found in the patient being reported.
This is particularly puzzling in patients with the syndrome related to interatrial communications. What is the mechanism for a right-to-left shunt in patients without pulmonary hypertension and normal hemodynamics? This puzzle has been restated as a question: “What causes
A New Therapeutic Approach
Given a patient with an interatrial communication and platypnea-orthodeoxia, the current approach is to consider surgical closure of the communication, say a patent foramen ovale. Indeed, investigation of the possibility of an interatrial communication is commonly justified by the availability of a surgical remedy, including new techniques using percutaneous catheters. The attractiveness of surgical closure is enhanced by the possibility of preventing paradoxical emboli. As a result, aged
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Platypnea-orthodeoxia: clinical profile, diagnostic workup, management and report of seven cases
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Incidence and size of patent foramen ovale during the first ten decades of life: an autopsy study of 965 normal hearts
Mayo Clin Proc
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Right to left inter-atrial shunting through a patent foramen ovale despite normal intra-cardiac pressures
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A communitywide assessment of the use of pulmonary artery catheters in patients with acute myocardial infarction
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Right to left interatrial shunt causing platypnea after pneumonectomy: a recent experience and diagnostic value of dynamic magnetic resonance imaging
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Reflect orthostatic dyspnea associated with pulmonary hypotension [abstract]
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(1949) - et al.
Postural cyanosis and angina pectoris following pneumonectomy: relief by closure of an inter-atrial septal defect
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(1956)
Cited by (48)
Hypovolemia Resulting in Platypnea-Orthodeoxia Syndrome
2016, Journal of Emergency MedicineStroke in a 59-year-old man
2011, Revue de Medecine InternePlatypnea-orthodeoxia syndrome associated with patent foramen ovale
2011, Medicina ClinicaPlatypnea orthodeoxia syndrome and bronchopleural fistula following right pneumonectomy: The first case of double misfortune following pneumonectomy
2011, International Journal of Surgery Case ReportsCitation Excerpt :The second is that altered anatomic relations between the inferior vena cava, the superior vena cava, and the atrial septum, especially after right pneumonectomy, could cause preferential flow from the inferior vena cava through a PFO even in the absence of a pressure gradient.5 The current treatment for POS caused by right to left shunting is the closure of the PFO surgically or percutaneously, the latter of which has been more frequently employed due to its less invasiveness.6 No case has been reported regarding the sequential treatment of post-pneumonectomy PFO and BPF for the same patient.
Delayed reopening of a hemodynamically significant patent foramen ovale after left lung transplantation: Emergency management
2010, Journal of Heart and Lung TransplantationCitation Excerpt :The underlying mechanism could be akin to what has been described in the case of the platypnea–orthodeoxia syndrome observed after pneumonectomy7–10 or in patients with an enlarged aortic root.11–13 Platypnea–orthodeoxia syndrome, characterized by the association of dyspnea and hypoxemia aggravated by upright position and relieved in the supine position, is related to intracardiac or intrapulmonary right-to-left shunting of various causes.14 In particular, it may appear after a pneumonectomy (most often a right pneumonectomy) after a variable delay.
Partially funded by The Sandler Family Supported Foundation