title: Percutaneous Intervention to Treat Platypnea-Orthodeoxia Syndrome: The Toronto Experience.
abstract: This study reviewed a series of patients treated with transcatheter closure of septal defect to treat platypnea-orthodeoxia syndrome, with specific attention to septal characteristics and device choice.
  
  
  
  Platypnea-orthodeoxia syndrome is an uncommon condition characterized by positional dyspnea and hypoxemia due to intracardiac right-to-left shunting through a patent foramen ovale (PFO), an atrial septal defect, or pulmonary arteriovenous malformations. Percutaneous closure of such defects is the treatment of choice.
  
  
  
  In this single-center series, 52 patients were treated with percutaneous closure of an interatrial communication after presentation between January 1997 and July 2015. Septal morphology, clinical, procedural, and outcomes data were analyzed.
  
  
  
  All patients had a PFO; however, nearly one-quarter required a non-PFO device (11 Amplatzer Septal Occluder and 1 post-infarct muscular VSD), as opposed to a dedicated PFO device to achieve shunt occlusion. These patients were characterized by an aneurysmal septum, shorter primum septum overlap with the secundum septum, and greater septal angulation from the midline. After closure, all demonstrated acute improvements in oxygen saturation (pre-procedure: 81 ± 8%; post-procedure: 95.1 ± 0.5% on room air). Each patient was treated with a single device and no one required re-intervention.
  
  
  
  Patients presenting with platypnea-orthodeoxia syndrome can be treated successfully with a percutaneous intervention often requiring a variety of devices. Those requiring a non-PFO-type device had a greater prevalence of an aneurysmal septum, shorter primum septal overlap with the secundum septum, and greater septal angulation with the midline.
authors.affiliation: Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network.
authors.forename: Ashish H
authors.initials: AH
authors.lastname: Shah
authors.affiliation: Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network.
authors.forename: Mark
authors.initials: M
authors.lastname: Osten
authors.affiliation: Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network.
authors.forename: Andrew
authors.initials: A
authors.lastname: Leventhal
authors.affiliation: Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bach
authors.affiliation: Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network.
authors.forename: Daniel
authors.initials: D
authors.lastname: Yoo
authors.affiliation: Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network.
authors.forename: Danny
authors.initials: D
authors.lastname: Mansour
authors.affiliation: The Labatt family Heart Centre, The Hospital for Sick Children, Division of Cardiology, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Lee
authors.initials: L
authors.lastname: Benson
authors.affiliation: Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network.
authors.forename: William M
authors.initials: WM
authors.lastname: Wilson
authors.affiliation: Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network. Electronic address: eric.horlick@uhn.ca.
authors.forename: Eric
authors.initials: E
authors.lastname: Horlick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D003326:Coronary Circulation; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011187:Posture; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012042:Registries; D012189:Retrospective Studies; D055989:Septal Occluder Device; D013577:Syndrome; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: interatrial communication; percutaneous device closure; platypnea–orthodeoxia syndrome