title: Closure of a patent foramen ovale in patients with platypnoea-orthodeoxia: a rare and overlooked cause of dyspnoea and hypoxaemia.
abstract: OBJECTIVE
  Platypnoea-orthodeoxia is a rare cause of dyspnoea and hypoxaemia induced by a change from supine to upright position resulting in veno-arterial shunting, usually through a patent foramen ovale. We aimed to describe our experience with closure of a patent foramen ovale in patients with platypnoea-orthodeoxia, and to increase awareness of this diagnosis.
  
  
  METHODS
  Eight patients (mean age 63 ± 12 years) were identified from hospital records between 2000 and 2013.
  
  
  RESULTS
  The underlying diseases were aortic aneurism (n = 3), cardiac transplantation (n = 2), left ventricular dilatation (n = 1), pulmonary fibrosis (n = 1), and recurrent pleural/pericardial effusion (n = 1). At presentation, mean oxygen saturation was 81 ± 8% in the upright position. All patients underwent transthoracic and transoesophageal echocardiography. Pulmonary pressures were normal at rest in all patients. A right-to-left shunt through a patent foramen was demonstrated after changing posture from supine to sitting. Closure of the patient foramen ovale was performed uncomplicated in all patients. Mean oxygen saturation post-procedure was 96 ± 2%. All but one patient experienced marked symptom relief.
  
  
  CONCLUSIONS
  The majority of patients with platypnoea-orthodeoxia can benefit from treatment of the underlying condition. In the present cohort, patients underwent uncomplicated catheter-based closure of the patient foramen ovale with subsequent improvement of oxygen saturation and symptom improvement.
authors.affiliation: a Department of Research in Cardiothoracic and Vascular Surgery , Aarhus University Hospital , Aarhus N , Denmark.
authors.forename: Thais Almeida Lins
authors.initials: TA
authors.lastname: Pedersen
authors.affiliation: a Department of Research in Cardiothoracic and Vascular Surgery , Aarhus University Hospital , Aarhus N , Denmark.|b Department of Cardiology , Aarhus University Hospital , Aarhus N , Denmark.
authors.forename: Signe Holm
authors.initials: SH
authors.lastname: Larsen
authors.affiliation: b Department of Cardiology , Aarhus University Hospital , Aarhus N , Denmark.
authors.forename: Jens Erik
authors.initials: JE
authors.lastname: Nielsen-Kudsk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D003718:Denmark; D004417:Dyspnea / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011187:Posture; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010100:Oxygen
keywords: hypoxemia; patent foramen ovale; right-to-left shunt; venoarterial shunting