Multi-modal and multi-postural assessment of platypnea-orthodeoxia syndrome triggered by stroke: A case report
Platypnea-orthodeoxia syndrome (POS) is a rare condition where patients suffer from dyspnea and reduced oxygenation while in the sitting position. A 69-year-old man initially experienced dyspnea and hypoxemia in the sitting position after developing hemiplegia and postural instability secondary to a...
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| Veröffentlicht in: | Journal of cardiology cases 2022-03, Vol.25 (3), p.163-165 |
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| creator | Matsuo, Keisuke Nakano, Shintaro Katayama, Masanori Hasegawa, Saki Fukushima, Kenji |
| description | Platypnea-orthodeoxia syndrome (POS) is a rare condition where patients suffer from dyspnea and reduced oxygenation while in the sitting position. A 69-year-old man initially experienced dyspnea and hypoxemia in the sitting position after developing hemiplegia and postural instability secondary to a cerebral hemorrhage, but the symptoms improved in the supine position. Transesophageal echocardiography revealed a patent foramen ovale (PFO). In the sitting or semi-Fowler position, increased right-left shunt was observed using Swan-Ganz catheterization and pulmonary perfusion scintigraphy. The PFO closure was performed, which obliterated dyspnea and hypoxemia in the sitting position. In POS associated with PFO, comprehensive pre-operative evaluation using multi-modality tests in different postural settings critically delineates the etiology that guides appropriate treatment strategy. |
| doi_str_mv | 10.1016/j.jccase.2021.08.007 |
| format | Article |
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<Learning objective: Pulmonary perfusion scintigraphy successfully demonstrated the postural change in shunt rate in patent foramen ovale (PFO). Further confirmation by cardiac catherization has strengthened the presumed mechanism (increased shunt and decreased oxygenation with coexisting right atrial pressure elevation) and underlying trigger (maintaining semi-Fowler position). Such multi-modal evaluation convinced us of the validity of invasive closing of PFO for relieving patient's symptoms. Thus, in platypnea-orthodeoxia syndrome associated with PFO, comprehensive pre-operative multi-modal evaluation of the patient in different postural settings is critical in determining the treatment strategy.></description><identifier>ISSN: 1878-5409</identifier><identifier>EISSN: 1878-5409</identifier><identifier>DOI: 10.1016/j.jccase.2021.08.007</identifier><identifier>PMID: 35261702</identifier><language>eng</language><publisher>Japan: Elsevier Ltd</publisher><subject>Case Report ; Patent foramen ovale ; Platypnea-orthodeoxia syndrome ; Pulmonary perfusion scintigraphy ; Swan-Ganz catheter</subject><ispartof>Journal of cardiology cases, 2022-03, Vol.25 (3), p.163-165</ispartof><rights>2021 Elsevier Ltd</rights><rights>2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.</rights><rights>2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. 2021 Elsevier Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3697-2a769746834c0602a49dc56405606f2c20974994ad6c41acf23f5a42404228e93</citedby><cites>FETCH-LOGICAL-c3697-2a769746834c0602a49dc56405606f2c20974994ad6c41acf23f5a42404228e93</cites><orcidid>0000-0003-2844-2284</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8888707/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1878540921001419$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,3537,27901,27902,53766,53768,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35261702$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Matsuo, Keisuke</creatorcontrib><creatorcontrib>Nakano, Shintaro</creatorcontrib><creatorcontrib>Katayama, Masanori</creatorcontrib><creatorcontrib>Hasegawa, Saki</creatorcontrib><creatorcontrib>Fukushima, Kenji</creatorcontrib><title>Multi-modal and multi-postural assessment of platypnea-orthodeoxia syndrome triggered by stroke: A case report</title><title>Journal of cardiology cases</title><addtitle>J Cardiol Cases</addtitle><description>Platypnea-orthodeoxia syndrome (POS) is a rare condition where patients suffer from dyspnea and reduced oxygenation while in the sitting position. A 69-year-old man initially experienced dyspnea and hypoxemia in the sitting position after developing hemiplegia and postural instability secondary to a cerebral hemorrhage, but the symptoms improved in the supine position. Transesophageal echocardiography revealed a patent foramen ovale (PFO). In the sitting or semi-Fowler position, increased right-left shunt was observed using Swan-Ganz catheterization and pulmonary perfusion scintigraphy. The PFO closure was performed, which obliterated dyspnea and hypoxemia in the sitting position. In POS associated with PFO, comprehensive pre-operative evaluation using multi-modality tests in different postural settings critically delineates the etiology that guides appropriate treatment strategy.
<Learning objective: Pulmonary perfusion scintigraphy successfully demonstrated the postural change in shunt rate in patent foramen ovale (PFO). Further confirmation by cardiac catherization has strengthened the presumed mechanism (increased shunt and decreased oxygenation with coexisting right atrial pressure elevation) and underlying trigger (maintaining semi-Fowler position). Such multi-modal evaluation convinced us of the validity of invasive closing of PFO for relieving patient's symptoms. Thus, in platypnea-orthodeoxia syndrome associated with PFO, comprehensive pre-operative multi-modal evaluation of the patient in different postural settings is critical in determining the treatment strategy.></description><subject>Case Report</subject><subject>Patent foramen ovale</subject><subject>Platypnea-orthodeoxia syndrome</subject><subject>Pulmonary perfusion scintigraphy</subject><subject>Swan-Ganz catheter</subject><issn>1878-5409</issn><issn>1878-5409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9UcFO3DAQtVARIOAPUOUfSBg7juP0UGm1KlCJigucLWNPdr3dxJGdRd2_x8vCll46lxl79N68mUfIFYOSAZPXq3JlrUlYcuCsBFUCNEfkjKlGFbWA9sun-pRcprSCHBUTqlYn5LSquWQN8DMy_NqsJ1_0wZk1NYOj_dt7DGnaxN1XSphSj8NEQ0fHtZm244CmCHFaBofhjzc0bQcXQ490in6xwIiOPm9pmmL4jd_ojO6E0ohjxlyQ486sE16-53PydPPjcX5X3D_c_pzP7gtbybYpuGlyElJVwoIEbkTrbC0F1BJkxy2H3G1bYZy0ghnb8aqrjeACBOcK2-qcfN_zjpvnHp3N-vM2eoy-N3Grg_H6387gl3oRXrTK0UCTCcSewMaQUsTugGWgdxbold5boHcWaFAa3mBfP889gD4O_lcY5u1fPEadrMfBovMR7aRd8P-f8ArP85t_</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Matsuo, Keisuke</creator><creator>Nakano, Shintaro</creator><creator>Katayama, Masanori</creator><creator>Hasegawa, Saki</creator><creator>Fukushima, Kenji</creator><general>Elsevier Ltd</general><general>Japanese College of Cardiology</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2844-2284</orcidid></search><sort><creationdate>20220301</creationdate><title>Multi-modal and multi-postural assessment of platypnea-orthodeoxia syndrome triggered by stroke: A case report</title><author>Matsuo, Keisuke ; Nakano, Shintaro ; Katayama, Masanori ; Hasegawa, Saki ; Fukushima, Kenji</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3697-2a769746834c0602a49dc56405606f2c20974994ad6c41acf23f5a42404228e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Case Report</topic><topic>Patent foramen ovale</topic><topic>Platypnea-orthodeoxia syndrome</topic><topic>Pulmonary perfusion scintigraphy</topic><topic>Swan-Ganz catheter</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Matsuo, Keisuke</creatorcontrib><creatorcontrib>Nakano, Shintaro</creatorcontrib><creatorcontrib>Katayama, Masanori</creatorcontrib><creatorcontrib>Hasegawa, Saki</creatorcontrib><creatorcontrib>Fukushima, Kenji</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of cardiology cases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Matsuo, Keisuke</au><au>Nakano, Shintaro</au><au>Katayama, Masanori</au><au>Hasegawa, Saki</au><au>Fukushima, Kenji</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multi-modal and multi-postural assessment of platypnea-orthodeoxia syndrome triggered by stroke: A case report</atitle><jtitle>Journal of cardiology cases</jtitle><addtitle>J Cardiol Cases</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>25</volume><issue>3</issue><spage>163</spage><epage>165</epage><pages>163-165</pages><issn>1878-5409</issn><eissn>1878-5409</eissn><abstract>Platypnea-orthodeoxia syndrome (POS) is a rare condition where patients suffer from dyspnea and reduced oxygenation while in the sitting position. A 69-year-old man initially experienced dyspnea and hypoxemia in the sitting position after developing hemiplegia and postural instability secondary to a cerebral hemorrhage, but the symptoms improved in the supine position. Transesophageal echocardiography revealed a patent foramen ovale (PFO). In the sitting or semi-Fowler position, increased right-left shunt was observed using Swan-Ganz catheterization and pulmonary perfusion scintigraphy. The PFO closure was performed, which obliterated dyspnea and hypoxemia in the sitting position. In POS associated with PFO, comprehensive pre-operative evaluation using multi-modality tests in different postural settings critically delineates the etiology that guides appropriate treatment strategy.
<Learning objective: Pulmonary perfusion scintigraphy successfully demonstrated the postural change in shunt rate in patent foramen ovale (PFO). Further confirmation by cardiac catherization has strengthened the presumed mechanism (increased shunt and decreased oxygenation with coexisting right atrial pressure elevation) and underlying trigger (maintaining semi-Fowler position). Such multi-modal evaluation convinced us of the validity of invasive closing of PFO for relieving patient's symptoms. Thus, in platypnea-orthodeoxia syndrome associated with PFO, comprehensive pre-operative multi-modal evaluation of the patient in different postural settings is critical in determining the treatment strategy.></abstract><cop>Japan</cop><pub>Elsevier Ltd</pub><pmid>35261702</pmid><doi>10.1016/j.jccase.2021.08.007</doi><tpages>3</tpages><orcidid>https://orcid.org/0000-0003-2844-2284</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of cardiology cases, 2022-03, Vol.25 (3), p.163-165 |
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| source | Elsevier ScienceDirect Journals Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Case Report Patent foramen ovale Platypnea-orthodeoxia syndrome Pulmonary perfusion scintigraphy Swan-Ganz catheter |
| title | Multi-modal and multi-postural assessment of platypnea-orthodeoxia syndrome triggered by stroke: A case report |
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