A Case of Platypnea-Orthodeoxia Syndrome Caused by a Patent Foramen Ovale

(Department of Cardiovascular Surgery, Showa General Hospital, Kodaira, Japan, Department of Cardiovascular Surgery, Koga General Hospital*, Miyazaki, Japan and Department of Cardiovascular Surgery, Saitama Medical University**, Saitama, Japanj

Hiroshi Hojo* Masahiko Ozaki Masanori Ogiwara
Yuuji Yokote** Shunnei Kyo**
We encountered a patient with platypnea-orthodeoxia syndrome. This rare syndrome is characterized by right-to-left shunt, which appears in the upright position. A 76-year-old woman with symptomatic hypoxemia was referred for evaluation and treatment. She did not complain of dyspnea while in a supine position, but experienced dyspnea with severe hypoxemia in a sitting or standing position. She did not have any pulmonary diseases that can be cause of dyspnea. Echocardiography revealed a patent foramen ovale and mild left-to-right shunt when the patient was supine. However in an upright position, right-to-left shunt appeared and the arterial oxygen saturation dropped from 95% to 80% with dyspnea. Cardiac catheterization revealed normal pulmonary artery pressure and right-to-left shunt through the patent foramen ovale in the sitting position. We then diagnosed platypnea-orthodeoxia syndrome. The chest CT showed deformity of the right atrium caused by compression of the elongated ascending aorta. The patent foramen ovale was closed and the ascending aorta was shortened by open heart surgery. Her dyspnea and hypoxemia in the upright position was completely resolved after surgery.
@Jpn. J. Cardiovasc. Surg. 36: 68-71 (2007)