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Abhinav Agrawal, Atul Palkar, Arunabh Talwar
Platypnea-Orthodeoxia syndrome (POS) is a rare clinical entity characterized by dyspnea and arterial desaturation while in the upright position. The various pathophysiologic mechanisms leading to POS has puzzled clinicians for years. The hypoxia in POS has been attributed to the mixing of the deoxygenated venous blood with the oxygenated arterial blood via a shunt. The primary mechanisms of POS in these patients can be broadly classified based on intracardiac abnormalities, extracardiac abnormalities and miscellaneous etiologies...
August 2017: Respiratory Medicine
R Swapna, Rahul Roshan, Sunil K Chhabra
Platypnea-orthodeoxia syndrome (POS), the occurrence of dyspnea and arterial desaturation on changing from supine to sitting position, is a very rare phenomenon. Most case reports have been in association with an intra-atrial communication, and observation of this unusual physiological abnormality in pulmonary conditions has been extremely rare. We present a case of idiopathic pulmonary fibrosis where the patient developed characteristic symptoms of POS when it was complicated by Pneumocystis jiroveci pneumonia...
July 2017: Lung India: Official Organ of Indian Chest Society
M Muratori, G Italiano, E Innocenti, L Fusini, M Mapelli, G Tamborini, S Ghulam Ali, P Gripari, A Maltagliati, F Celeste, M Pepi
Background.: The presence of patent foramen ovale (PFO) has been linked to many illness, including cryptogenic stroke, transient ischemic attack, migraine, platypnea-orthodeoxia syndrome and decompression sickness in scuba divers. Transesophageal echocardiography is the gold standard technique for the visualization of atrial septal anatomy, but it is a secondary level exam, not always available, with additional associated costs and not completely free from procedural risks. Standard transthoracic echocardiography (TTE) has a too low sensitivity for PFO screening...
December 1, 2016: European Heart Journal Cardiovascular Imaging
Ippei Tsuzuki, Kamon Iigaya, Takashi Matsubara, Shunsuke Takagi, Taku Inohara, Yasuyuki Ohgino, Toshio Imafuku
BACKGROUND: Platypnea-orthodeoxia syndrome is a rare syndrome characterized by dyspnea and hypoxia when the patient is sitting or standing. Here we report a case of platypnea-orthodeoxia syndrome caused by a right hemidiaphragmatic elevation with giant liver cyst that triggered a right-to-left shunt through the patent foramen ovale. This case report is the first presentation of a case secondary to hemidiaphragmatic elevation with giant liver cyst. In addition to this, a malposition of the pacemaker lead could be associated with platypnea-orthodeoxia syndrome in this case...
April 12, 2017: Journal of Medical Case Reports
Rishik Vashisht, Siddharth Dugar, Narendrakumar Alappan, Ajit Moghekar
No abstract text is available yet for this article.
April 2017: Annals of the American Thoracic Society
V Mercier, G Tragas, P Compère, P Lefebvre, A Van Meerhaeghe
The plathypnea orthodeoxia syndrome is a rare condition that is characterized by dyspnea and hypoxia that occurs in the upright position and improves with recumbency. The diagnostic is often made tardively and requires the combination of two components: a mechanical one (for example a patent foramen ovale) and a kinetic one (for example COPD). This combination contributes to the blood flow through the communication. The treatment consists of closing the veno-arterial communication (in the case of a patent foramen ovale, the closing of the inter-atrial septum) (Knapper et al, 2014)...
April 2017: Revue de Pneumologie Clinique
Esther González-Bartol, Antonio Rojas-González, Pablo Díez-Villanueva, Carmen Acosta-Gutiérrez, Eduardo Pozo-Osinalde, Fernando Alfonso
No abstract text is available yet for this article.
January 23, 2017: Archivos de Cardiología de México
Shuichiro Kazawa, Takashi Enomoto, Naomasa Suzuki, Tomoyasu Koshikawa, Yuka Okubo, Shinpei Yoshii, Masahito Sato, Masaaki Okabe, Akira Yamashina, Yoshifusa Aizawa
A 77-year-old woman developed dyspnea over three years which occurred during sitting, standing or walking. Her physical examination, chest X-ray, ECG and cardiac catheterization results were all normal. A marked fall in arterial oxygen saturation was observed on sitting or standing. Transesophageal echocardiography showed an increase of right to left shunt flow on sitting. The patient was diagnosed with platypnea-orthodeoxia syndrome and underwent the surgical closure of an atrial septal defect of 19 mm in diameter...
2017: Internal Medicine
C Craig Rudy, Cody Ballard, Craig Broberg, Alan J Hunter
A 75-year-old man with chronic (30-year) unexplained paroxysmal hypoxemia presented with postural hypoxemia and desaturation consistent with a clinical manifestation of platypnea-orthodeoxia syndrome. His history included a lack of significant past pulmonary disease, yet with intermittent need for oxygen supplementation. On admission he was found to have an interatrial shunt through a patent foramen ovale. Device closure by percutaneous catheterization led to sustained resolution of symptoms. Platypnea-orthodeoxia syndrome is a rare but important consideration in the differential diagnosis of hypoxemia, as it represents a potentially curable cause of hypoxemia, with missed diagnosis leading to possible patient morbidity if untreated...
January 2017: Journal of General Internal Medicine
Kevin O'Gallagher, Evelyn Chou, Swarna Jeyabraba, Aish Sinha, Daniel Robb, Jonathan Byrne
An 80-year-old female presented with progressive breathlessness, worse on sitting or standing and relieved by lying flat. Subsequent investigations identified a patent foramen ovale (PFO) with right-to-left flow across the interatrial septum (IAS). A diagnosis of platypnoea orthodeoxia syndrome secondary to inter-atrial shunting was made. Technical features precluded a percutaneous PFO closure so an open surgical repair was performed with complete resolution of symptoms. We discuss the pathophysiology and management of platypnoea orthodeoxia syndrome...
October 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
Renato De Vecchis, Cesare Baldi, Carmelina Ariano
Platypnea-orthodexia syndrome (POS) is often a challenging diagnostic problem. It is characterized by dyspnea that is accentuated by standing or sitting positions due to a marked fall in blood oxygen saturation, and instead is improved by assuming the lying position. In the present brief review, the authors address the pathophysiology of POS, and outline its clinical symptoms as well as the main modalities of diagnostic evaluation and possible therapeutic options. Moreover, some problems concerning much-debated issues and persistent uncertainties about the pathophysiology of POS are presented along with the description of the diagnostic and therapeutic resources currently available for this syndrome...
September 23, 2016: Journal of Clinical Medicine
Jonathan Marvin Tobis, Islam Abudayyeh
No abstract text is available yet for this article.
September 26, 2016: JACC. Cardiovascular Interventions
Ashish H Shah, Mark Osten, Andrew Leventhal, Yvonne Bach, Daniel Yoo, Danny Mansour, Lee Benson, William M Wilson, Eric Horlick
OBJECTIVES: This study reviewed a series of patients treated with transcatheter closure of septal defect to treat platypnea-orthodeoxia syndrome, with specific attention to septal characteristics and device choice. BACKGROUND: Platypnea-orthodeoxia syndrome is an uncommon condition characterized by positional dyspnea and hypoxemia due to intracardiac right-to-left shunting through a patent foramen ovale (PFO), an atrial septal defect, or pulmonary arteriovenous malformations...
September 26, 2016: JACC. Cardiovascular Interventions
R De Vecchis, C Baldi, C Ariano, A Giasi, C Cioppa
Platypnea-orthodeoxia syndrome (POS) is a rare disorder characterized by the emergence of a right-to-left shunt at the intracardiac or intrapulmonary level. The clinical picture is distinguished by shortness of breath that worsens on standing due to an accentuation of oxygen desaturation, and instead improves, at least partly, in the recumbent position. In this article we present a brief review of the pathophysiology of POS, as well as its clinical picture, diagnostic assessment, and preferential therapeutic options...
September 12, 2016: Herz
Lucas S Zier, Horst Sievert, Vaikom S Mahadevan
Patent foramen ovale (PFO) is a common congenital cardiac abnormality and that has been associated with several disease processes including transient ischemic attacks (TIA), stroke, migraine headaches with aura, decompression sickness, platypnea-orthodeoxia syndrome, and shunt induced cyanosis. Controversy exists regarding closure of PFO as a therapeutic treatment modality for these disease processes. This review addresses the contemporary clinical indications for PFO closure. Areas covered: We conducted a comprehensive literature search of contemporary research studies focusing on randomized trials and meta-analyses comparing medical therapy and device closure of PFOs for the treatment of PFO associated clinical syndromes...
November 2016: Expert Review of Cardiovascular Therapy
Andrew K Roy, Jerome Garot, Antoinette Neylon, Marco Spaziano, Fadi J Sawaya, Thierry Lefèvre
Progressive dyspnea and hypoxaemia in the subacute phase after transcatheter aortic valve implantation (TAVI) are uncommon and warrant immediate assessment of valve and prosthesis leaflet function to exclude thrombosis, as well as investigation for other causes related to the procedure, such as left ventricular dysfunction, pulmonary embolism, and respiratory sepsis. In this case, we report the observation of a patient presenting two weeks after TAVI with arterial hypoxaemia in an upright position, relieved by lying flat, and coupled with an intracardiac shunt detected on echocardiography in the absence of pulmonary hypertension, raising the suspicion of Platypnea-Orthodeoxia Syndrome (POS)...
2016: Case Reports in Cardiology
Takayuki Sekihara, Masahiro Kimura, Daisuke Hazama, Yuki Kimura, Hideyuki Hayashi, Mitsumasa Okano, Moritoshi Funasako, Kenichi Sasaki, Eisaku Nakane, Shoichi Miyamoto, Toshiaki Izumi, Tetsuya Haruna, Motonari Fukui, Moriaki Inoko
Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by interatrial right-to-left shunting that is exacerbated in the upright position. We herein report a 78-year-old woman with POS that remained undiagnosed for 2 years, despite repetitive transthoracic echocardiography (TTE). POS was ultimately diagnosed using contrast transesophageal echocardiography (TEE), which revealed a marked increase in right-to-left shunting in the sitting position, associated with simultaneous desaturation. Therefore, we propose that POS should be considered according to the clinical symptoms, regardless of the repetitive TTE results, and contrast TEE should be performed in both the supine and sitting positions to exclude a diagnosis of POS...
2016: Internal Medicine
Keita Masuzawa, Toshimitsu Tsugu, Mitsushige Murata, Iwao Nakamura, Marohito Murakami, Hikaru Tsuruta, Akio Kawamura, Soushin Inoue, Keiichi Fukuda
No abstract text is available yet for this article.
April 10, 2016: Nihon Naika Gakkai Zasshi. the Journal of the Japanese Society of Internal Medicine
Paul Abraham, Diego Quattrone, Nicolas Pecquerie, Zoé Schmitt, Mathieu Gazon, Serge Duperret
No abstract text is available yet for this article.
December 2016: Minerva Anestesiologica
Pieter Ghijselinck, Jan Van den Saffele, Geert Hollanders
We present the case of a 85-year-old patient admitted with palpitations and dyspnea. When assuming a recumbent position, we noticed a significant improvement in dyspnea, as well as a rise in arterial oxygen saturation. This is a typical presentation of platypnea-orthodeoxia syndrome (POS). The diagnosis was confirmed by serial analyses of the arterial oxygen saturation in different positions. In our patient, POS was caused by a cardiac right-left shunt through a patent foramen ovale, facilitated by an atrial septal aneurysm, a dilated aortic root and a large Eustachian valve...
June 2017: Acta Clinica Belgica
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