Platypnea-Orthodeoxia Syndrome Due to Patent Foramen Ovale: A Diagnostic and Therapeutic Challenge.

Q4 Medicine

JACC. Case reports Pub Date : 2025-06-27 DOI:10.1016/j.jaccas.2025.104433

Michelle Carrasquel-Alvarez, Khaleel Quasem, Varun George, Lee Elisevich, Majid Mughal

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Abstract

Background: Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnea and hypoxia exacerbated by an upright position. It is often associated with intracardiac or pulmonary shunting.

Case summary: An 82-year-old woman presented with increasing fatigue, dizziness, and worsening dyspnea on exertion for 1 month. She was hypoxic, requiring high-flow oxygen. Initial work-up, including imaging and right heart catheterization, revealed an aneurysmal interatrial septum with a right-to-left shunt through a patent foramen ovale (PFO). The patient underwent successful percutaneous closure of the PFO, resulting in resolution of hypoxia and dyspnea.

Discussion: POS should be suspected in cases of positional hypoxia. The pathophysiology involves anatomical and hemodynamic factors that promote right-to-left shunting in specific positions. PFO closure is the definitive treatment, leading to symptom resolution.

Take-home messages: POS should be considered in patients with unexplained positional hypoxia. PFO closure can significantly improve symptoms and quality of life in affected patients.

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由卵圆孔未闭引起的通气-正氧综合征：诊断和治疗的挑战。

背景：直立呼吸-正氧综合征（POS）是一种罕见的以直立体位加重呼吸困难和缺氧为特征的疾病。它常伴有心内或肺分流。病例总结：一名82岁女性在劳累1个月后出现疲劳、头晕和呼吸困难加重。她缺氧，需要高流量氧气。初步检查，包括影像学检查和右心导管检查，发现动脉瘤性房间隔，并通过卵圆孔未闭（PFO）右至左分流。患者成功经皮缝合PFO，缺氧和呼吸困难得到缓解。讨论：体位性缺氧时应怀疑POS。病理生理包括促进特定位置右向左分流的解剖和血流动力学因素。PFO关闭是最终的治疗方法，导致症状缓解。关键信息：有不明原因体位性缺氧的患者应考虑POS。PFO闭合可显著改善患者的症状和生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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