Abstract
Platypnea-orthodeoxia syndrome is a condition of dyspnea and hypoxia whilst in the upright position, which improves in the recumbent position. We present a case of platypnea-orthodeoxia due to a fenestrated atrial septal aneurysm that induced recurrent strokes and a recent condition of fluctuating confusion and cognitive impairment, modified by position, associated with rapid variations of O2 saturation position related. The suspect of platypnea-orthodeoxia syndrome may be hypothesized in case of patients with recurrent cerebral ischemia and fluctuating cognitive disturbances induced by change of position. In those cases a careful echocardiographic evaluation and O2 saturation determination in up and downright position are required.
Highlights
Platypnea-orthodeoxia syndrome is a rare condition in which dyspnea and hypoxia concurrently appear in the upright position and are relieved by clinostatism
The particular anatomic conditions requested the positioning of multiple devices in order to obtain a satisfactory reduction of the shunting. In our patient both clinical and laboratory findings suggested an unusual disorder known as platynea-orthodeoxia syndrome
This pathological condition has been described in association to pulmonary diseases – including pulmonary arteriovenous malformations, chronic obstructive bronchopneumopathy, pulmonary fibrosis, kyphoscoliosis – or cardiac diseases in presence of secundum atrial septal defect or patent foramen ovale – in association with septal
Summary
Platypnea-orthodeoxia syndrome is a rare condition in which dyspnea and hypoxia concurrently appear in the upright position and are relieved by clinostatism. Pulmonary and right atrial pressures are not elevated [1]. Some conditions are associated with this rare syndrome, including cardiac, pulmonary or, in a few cases, hepatic alterations [2], which can account for the variable concomitant clinical manifestations in these patients. We present a patient with typical manifestations of POS in whom the appearance of neurological symptoms brought him to medical attention. The electrocardiogram showed sinus tachycardia (105 bpm) with left atrial enlargement and incomplete right bundle branch block. Transthoracic (TTE) and transesophageal echocardiogram (TEE) showed the presence of an aneurysmal interatrial septum. Significant right-to-left shunting, while absent in recumbent position, appeared at a 70 degree incline. The particular anatomic conditions requested the positioning of multiple devices in order to obtain a satisfactory reduction of the shunting
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