Abstract 17194: Clinically Successful Percutaneous Treatment of Platypnea Orthodeoxia Syndrome in Patients With Patent Foramen Ovale

IntroductionPlatypnea-orthodeoxia syndrome (POS) is a rare clinical entity, characterized by dyspnea and desaturation while in the upright position, relieved in the supine position. POS can be caused by extracardiac abnormalities, but mainly because of intracardiac abnormalities, among which patent foramen ovale (PFO) is the most common etiology, followed by atrial septal defect or atrial septal aneurysm.HypothesisPatients with POS attributable to PFO may be successfully and safely treated with percutaneous closure of the PFO, in order to improve functional class, and oxygen saturation in both upright and supine positions.MethodsWe analyzed all patients diagnosed with POS secondary to PFO, and sent to our catheterization laboratory, between 2009 and 2019. Other causes of dyspnea and oxygen desaturation, including significant pulmonary disease, were excluded. We recorded clinical basal characteristics including NYHA functional class and oxygen saturation in supine position and in orthostatism, at baseline and in the follow-up, and hemodynamic parameters during invasive heart catheterization before and after PFO closure, as well as eventual complications related to the procedure.ResultsWe analyzed 18 consecutive patients (55,5% women, age 69±9 years) in the aforementioned period. All patients were in NYHA functional class II or III before PFO closure. Mean oxygen saturation in supine position was 93±2% and in orthostatism was 79±6%. Before PFO closure, mean pulmonary artery pressure, right atrial pressure and Qp/Qs were 13±5 mmHg, 5±3 mmHg and 0.8±0.1 respectively. All procedures were guided with intracardiac echocardiography. PFO closure was successfully performed in all 18 cases. 15 patients (83.3%) experimented an improvement in their NYHA functional class in the follow-up (p=0,0002). Oxygen saturation values in supine and in upright position were significantly higher after the procedure (p=0.002 and p=0.001 respectively). No differences were observed between oxygen saturation in supine and in upright position after PFO closure (p>0,05).ConclusionsPercutaneous closure of PFO in patients with POS could be an effective and safe treatment option, improving oxygen saturation and NYHA functional class in the follow-up.