Citation Information :
Gallagher G, Joseph A, Rajendram R. Platypnea-Orthodeoxia: Patent Foramen Ovale Unmasked by Pulmonary Emboli. Indian J Respir Care 2018; 7 (1):50-52.
This report describes an 84 year old woman who presented with breathlessness from platypnea-orthodeoxia. This was due to a distortion of a patent foramen ovale by lower thoracic vertebral fractures which allowed a right-to-left intracardiac shunt. The right-to-left shunt was, in this case, triggered by small bilateral pulmonary emboli. Platypnea-orthodeoxia is rare, complex, and underdiagnosed. The pathogenesis requires an anatomical substrate for a shunt and a functional component that triggers reversal of the flow across it. Recognition is critical and may prevent provision of sedation, invasive ventilatory support, and vasopressor; all of which actually exacerbate right-to-left extrapulmonary shunt.
Hegland DD, Kunz GA, Harrison JK, Wang A. A hole in the argument. N Engl J Med 2005;353:2385-90.
Rao PS. Transcatheter management of platypnea-orthodeoxia syndrome. J Invasive Cardiol 2004;16:583-4.
Knapper JT, Schultz J, Das G, Sperling LS. Cardiac platypnea-orthodeoxia syndrome: An often unrecognized malady. Clin Cardiol 2014;37:645-9.
Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: An autopsy study of 965 normal hearts. Mayo Clin Proc 1984;59:17-20.
Mekontso Dessap A, Boissier F, Leon R, Carreira S, Campo FR, Lemaire F, et al. Prevalence and prognosis of shunting across patent foramen ovale during acute respiratory distress syndrome. Crit Care Med 2010;38:1786-92.
Védrinne JM, Duperret S, Gratadour P, Barthélémy C, Motin J. Effects of mechanical ventilation with PEEP on right to left intra-cardiac shunt caused by patent foramen ovale. Ann Fr Anesth Reanim 1995;14:387-92.
Hermans GM, Wilmer A, Knockaert DC, Bobbaers H. Acute intracardiac right-to-left shunt in a patient with acute respiratory distress syndrome and shock successfully treated with nitric oxide. Br J Anaesth 2006;96:268-9.
Blanche C, Noble S, Roffi M, Testuz A, Müller H, Meyer P, et al. Platypnea-orthodeoxia syndrome in the elderly treated by percutaneous patent foramen ovale closure: A case series and literature review. Eur J Intern Med 2013;24:813-7.