Dyspnea after pneumonectomy: the result of an atrial septal defect

What the cardiologist should know about the management of platypnea-orthodeoxia syndrome

Platypnea-orthodeoxia syndrome is a rare and poorly understood condition related to the development of a right-to-left intracardiac shunt at the atrial level through a benign and silent patent foramen ovale. It is usually recognized after major lung resection, recurrent pulmonary embolism or chronic lung disease. Orthostatic dyspnea and cyanosis is the prominent clinical presentation. Symptoms increase in the upright position and are relieved by recumbency. Our report describes the clinical course of a patient with severe hypoxemia after left pneumonectomy attributable to a right-to-left shunting through an atrial septal defect.

Pneumonectomy in the seventh decade in a patient with a congenital uncorrected ventricular septal defect

We describe the successful treatment of a patient in his seventh decade with a congenital uncorrected ventricular septal defect (VSD), moderate aortic stenosis and carcinoma of the lung, who underwent a successful pneumonectomy. Preoperative and intraoperative assessment of pulmonary artery pressure are essential to manage this combination of cardiac and thoracic pathologies. After pneumonectomy, echocardiography can be difficult. Magnetic resonance imaging (MRI) is useful to assess intra-cardiac defects in this situation.

A rare complication of pneumonectomy: Diagnosis made by a literature search

This case describes platypnoea-orthodeoxia syndrome in a patient 2 months after a right pneumonectomy for adenocarcinoma of the lung. The patient complained of platypnoea (breathlessness in the upright position) and was noted to have orthodeoxia (arterial desaturation on standing) on clinical examination. This was due to anatomical changes after the pneumonectomy that resulted in direct blood flow from the inferior vena cava through a previously unrecognised atrial septal defect into the left atrium. The closure of this right to left shunt with an Amplatzer occluder produced immediate and striking symptomatic relief in the patient. The authors had no previous experience of this very rare complication of pneumonectomy. The diagnosis was made after a literature search using PubMed/Medline, underlining the direct clinical benefit provided by these databases.