title: Dyspnea in a nonagenarian: The usual suspects, an unexpected culprit.
abstract: Platypnea-orthodeoxia syndrome (POS) is an uncommon syndrome characterized by dyspnea and hypoxemia triggered by orthostatism and relieved by recumbency. It is often associated with an interatrial shunt through a patent foramen ovale (PFO). We report the case of a 92-year-old woman initially admitted in the setting of a traumatic femoral neck fracture (successfully treated with hip replacement surgery) in whom a reversible decline in transcutaneous oxygen saturation from 98% (in the supine position) to 84% (in the upright position) was noted early post-operatively. Thoracic multislice computed tomography excluded pulmonary embolism and severe parenchymal lung disease. The diagnosis of POS was confirmed by tilt-table contrast transesophageal echocardiography, which demonstrated a dynamic and position-dependent right-to-left shunt (torrential when semi-upright and minimal in the supine position) through a PFO. The patient underwent percutaneous closure of the PFO with an Amplatzer device, which led to prompt symptom relief and full functional recovery.
authors: Hospital de Santa Cruz, Carnaxide, Portugal. Electronic address: serg.lou.madeira@gmail.com.
authors: Sérgio
authors: S
authors: Madeira
authors: Hospital de Santa Cruz, Carnaxide, Portugal.
authors: Luís
authors: L
authors: Raposo
authors: Hospital da Luz, Lisboa, Portugal.
authors: Raquel
authors: R
authors: David
authors: Hospital da Luz, Lisboa, Portugal.
authors: Alexandre
authors: A
authors: Marques
authors: Hospital da Luz, Lisboa, Portugal.
authors: José
authors: J
authors: Andrade Gomes
authors: Hospital da Luz, Lisboa, Portugal.
authors: Nuno
authors: N
authors: Cardim
authors: Hospital de Santa Cruz, Carnaxide, Portugal.
authors: Rui
authors: R
authors: Anjos
mesh_terms: D000369:Aged, 80 and over; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications*; D006801:Humans
keywords: Ecocardiografia transesofágica; Encerramento percutâneo; Foramen ovale patente; Inclinação dinâmica; Patent foramen ovale; Percutaneous closure; Platypnea-orthodeoxia syndrome; Síndrome platipneia-ortodeoxia; Tilt table; Transesophageal echocardiography