Anatomical factors triggering platypnea-orthodeoxia in adults.
Right to left shunting through a patent foramen ovale (PFO) or atrial septal defect (ASD) can cause platypnea-orthodeoxia even in a setting of normal pulmonary artery pressures. However, the late onset of symptoms despite the congenital origin of the anatomical defects is not well understood. We report a case series of patients presenting with dyspnea and orthodeoxia who developed right to left shunting as a result of associated anatomical changes that occur with aging such as tortuosity and elongation of the aorta. We propose that these acquired anatomical changes can favor right to left shunting in the setting of congenital abnormalities, therefore explaining the late onset of symptoms.
Sanikommu
Vijaya
V
The Gerald McGinnis Cardiovascular Institute, Department of Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212 USA. ipoornim@wpahs.org
Lasorda
David
D
Poornima
Indu
I
D000367:Age Factors; D000368:Aged; D000375:Aging; D001011:Aorta / Q000473:pathology* / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000295:instrumentation; D003964:Diaphragm / Q000473:pathology* / Q000503:physiopathology; D004417:Dyspnea / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010243:Paralysis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D012307:Risk Factors; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D016896:Treatment Outcome