[Platypnea-orthodeoxia syndrome, atrial septal aneurysm and right hemidiaphragmatic elevation with a right-to-left shunt through a patent foramen ovale].
Platypnea-orthodeoxia is an uncommon syndrome of dyspnea and hypoxemia induced by upright position, which is subsequently relieved by recumbency. The case reported involved a 75-year-old man with a seven days history of dyspnea in the upright position. The chest radiograph and CT scan demonstrated an elevated right hemidiaphragm. A surface echocardiogram with saline solution showed a patent foramen ovale (PFO) and atrial septal aneurysm. A pulmonary arteriogram was performed showing no evidence of pulmonary embolism and normal pulmonary arterial pressures. Later, he also developed dyspnea in the supine position and a transesophageal echocardiogram with contrast demonstrated a large right to left shunt through a PFO. The closure by a catheter-deployed double-umbrella device caused an immediate improvement in the patient's oxygenation.
Lopez Gaston
Osvaldo D
OD
División Terapia Intensiva, Policlínica Bancaria, Buenos Aires, Argentina. odlogaston@hotmail.com
Calnevaro
Oscar
O
Gallego
Claudio
C
Bluguermann
Jorge
J
Barbieri
David
D
Granja
Miguel
M
Mc Loughlin
Diego
D
Malvino
Eduardo
E
D000368:Aged; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D006322:Heart Aneurysm / Q000150:complications / Q000503:physiopathology*; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011187:Posture; D012133:Respiratory Paralysis / Q000150:complications*; D013577:Syndrome