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Gama E Castro A, Luz A, Oliveira F, Brochado B, Santos R, Alexandre A, Campinas A, Couto DS, Silveira J, Torres S. Platypnea Orthodeoxia Syndrome and Patent Foramen Ovale Closure: Single-Centre Experience and Long-Term Follow-Up. Heart Lung Circ 2022; 31:1547-1552. [PMID: 35987719 DOI: 10.1016/j.hlc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Platypnea orthodeoxia syndrome (POS) is an uncommon condition characterised by dyspnoea and arterial desaturation induced by an upright position and relieved in the supine position, usually due to a patent foramen ovale (PFO). Percutaneous closure of a PFO is the preferred treatment to cure POS. This study aimed to evaluate the clinical and gasometrical characteristics and to describe the long-term outcomes of percutaneous PFO closure in a group of patients with POS. METHODS Patients with POS and a PFO treated by percutaneous intervention from 2010-2020 were reviewed. The primary efficacy outcome was the arterial oxygen pressure to fraction of inspired oxygen (PaO2/FiO2) ratio before and 24 hours after the procedure. Total clinical success was considered if the arterial oxygen saturation measured by pulse oximetry (SpO2) improved to >94% in the supine and sitting positions without supplemental oxygen, while partial success was considered if SpO2 improved from baseline but still required oxygen to achieve >94%. Secondary outcomes were an absolute improvement in SpO2 and sense of dyspnoea, without significant residual shunt on transthoracic echocardiography (TTE) at follow-up. RESULTS Of 168 patients undergoing PFO or atrial septal defect closure, 14 had POS (8.3%). Percutaneous PFO closure was successfully performed in all patients with a single device. Twelve of 14 patients had total clinical success (86%) and one patient had partial success. The PaO2/FiO2 ratio increased from 155.9±50.6 to 318.3±73.4 after PFO closure (p=0.002). All patients with total clinical success had a successful secondary efficacy outcome with an absolute improvement in SpO2 and complete resolution of dyspnoea, which was maintained at follow-up (37±20 months; range, 11 months to 6 years). None had a significant residual shunt between 12 and 24 months of follow-up. CONCLUSION The PFO percutaneous closure was a successful, durable and safe method for patients presenting with POS; it achieved major improvements in both gasometrical parameters and quality of life.
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Affiliation(s)
- Ana Gama E Castro
- ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - André Luz
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal; Cardiovascular Research Group - Unit of Multidisciplinary Investigation in Biomedicine, ICBAS, Porto University, Porto, Portugal.
| | - Filomena Oliveira
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - Bruno Brochado
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - Raquel Santos
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - André Alexandre
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - Andreia Campinas
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - David Sá Couto
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - João Silveira
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - Severo Torres
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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Navarro Esteva J, Ortega Trujillo JR. Tratamiento efectivo en ortodeoxia e hipoxemia grave. Arch Bronconeumol 2020; 56:333-334. [DOI: 10.1016/j.arbres.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/23/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
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Collado FMS, Poulin MF, Murphy JJ, Jneid H, Kavinsky CJ. Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders. J Am Heart Assoc 2018; 7:e007146. [PMID: 29910192 PMCID: PMC6220531 DOI: 10.1161/jaha.117.007146] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Fareed Moses S Collado
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Marie-France Poulin
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Joshua J Murphy
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Hani Jneid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Clifford J Kavinsky
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
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Alkhouli M, Gagel A, Mathur M, O'Murchu B. Platypnea-orthodeoxia syndrome: an unusual complication of partial liver resection. Intern Med 2015; 54:1067-9. [PMID: 25948349 DOI: 10.2169/internalmedicine.54.3617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Platypnea-orthodeoxia syndrome (POS) is a rare syndrome of severe hypoxemia upon assuming an upright position. It is classically described as shunting from the right atrium to the left atrium usually via a patent foramen ovale (PFO). Alterations in the intrathoracic anatomy after liver resection and regeneration may trigger this condition in patients with clinically silent PFO -a previously unreported cause of POS.
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Casanovas-Marbà N, Feijoo-Massó C, Guillamón-Torán L, Guillaumet-Gasa E, Blanco BGD, Martínez-Rubio A. Patent foramen ovale causing severe hypoxemia due to right-to-left shunting in patients without pulmonary hypertension. Clinical suspicion clues for diagnosis and treatment. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:324-325. [PMID: 24774598 DOI: 10.1016/j.rec.2013.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 09/18/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Núria Casanovas-Marbà
- Servicio de Cardiología, Hospital de Sabadell-Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
| | - Carlos Feijoo-Massó
- Servicio de Cardiología, Hospital de Sabadell-Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
| | - Laura Guillamón-Torán
- Servicio de Cardiología, Hospital de Sabadell-Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
| | - Eva Guillaumet-Gasa
- Servicio de Cardiología, Hospital de Sabadell-Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
| | | | - Antoni Martínez-Rubio
- Servicio de Cardiología, Hospital de Sabadell-Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain.
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Casanovas-Marbà N, Feijoo-Massó C, Guillamón-Torán L, Guillaumet-Gasa E, García-del Blanco B, Martínez-Rubio A. Hipoxemia grave por shunt derecha–izquierda a través del foramen oval en ausencia de hipertensión pulmonar. Existe y se puede tratar con éxito. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.09.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cruz-González I, Solis J, Kiernan TJ, Yan BP, Lam YY, Palacios IF. Clinical manifestation and current management of patent foramen ovale. Expert Rev Cardiovasc Ther 2014; 7:1011-22. [DOI: 10.1586/erc.09.62] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Rajani R, Lee L, Sohal M, Khawaja M, Hildick-Smith D. Redo patent foramen ovale closure for persistent residual right-to-left shunting. EUROINTERVENTION 2011; 6:735-9. [DOI: 10.4244/eijv6i6a124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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