Dual mechanism platypnea-orthodeoxia syndrome from severe right coronary artery stenosis and a patent foramen ovale.
Platypnea-orthodeoxia is a rare clinical syndrome characterized by hypoxemia induced during upright posture. Multiple mechanisms have been proposed to explain this clinical entity, usually involving posture-provoked intracardiac or transpulmonary shunting. In many cases, however, a single etiology may not be evident, and multiple factors are likely contributory. We herein describe an unusual and novel case of platypnea-orthodeoxia caused by the physiologic interaction between a severe proximal right coronary artery stenosis and a large patent foramen ovale. Percutaneous stenting of the right coronary artery and transcatheter closure of the patent foramen ovale during the same setting resulted in complete resolution of the patient's symptoms.
Yeo
Khung Keong
KK
Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California 95817, USA.
Rogers
Jason H
JH
D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D011187:Posture / Q000502:physiology*; D011669:Pulmonary Wedge Pressure; D012720:Severity of Illness Index; D013577:Syndrome; D017725:Ventricular Pressure