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Heart, Lung and Circulation

Platypnoea Orthodeoxia Syndrome and Patent Foramen Ovale Closure: Single-Centre Experience and Long-Term Follow-Up

  • Author Footnotes
    1 Co-first authors.
    Ana Gama e Castro
    Footnotes
    1 Co-first authors.
    Affiliations
    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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  • Author Footnotes
    1 Co-first authors.
    André Luz
    Correspondence
    Corresponding author at: Cardiology Department, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
    Footnotes
    1 Co-first authors.
    Affiliations
    Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal

    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal

    Cardiovascular Research Group – Unit of Multidisciplinary Investigation in Biomedicine, ICBAS, Porto University, Porto, Portugal
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  • Filomena Oliveira
    Affiliations
    Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal

    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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  • Bruno Brochado
    Affiliations
    Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal

    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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  • Raquel Santos
    Affiliations
    Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal

    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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  • André Alexandre
    Affiliations
    Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal

    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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  • Andreia Campinas
    Affiliations
    Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal

    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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  • David Sá Couto
    Affiliations
    Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal

    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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  • João Silveira
    Affiliations
    Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal

    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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  • Severo Torres
    Affiliations
    Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal

    ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
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  • Author Footnotes
    1 Co-first authors.
Published:August 17, 2022DOI:https://doi.org/10.1016/j.hlc.2022.07.003

      Introduction

      Platypnoea orthodeoxia syndrome (POS) is an uncommon condition characterised by dyspnoea and arterial desaturation induced by an upright position and relieved in the supine position, usually due to a patent foramen ovale (PFO). Percutaneous closure of a PFO is the preferred treatment to cure POS. This study aimed to evaluate the clinical and gasometrical characteristics and to describe the long-term outcomes of percutaneous PFO closure in a group of patients with POS.

      Methods

      Patients with POS and a PFO treated by percutaneous intervention from 2010–2020 were reviewed. The primary efficacy outcome was the arterial oxygen pressure to fraction of inspired oxygen (PaO2/FiO2) ratio before and 24 hours after the procedure. Total clinical success was considered if the arterial oxygen saturation measured by pulse oximetry (SpO2) improved to >94% in the supine and sitting positions without supplemental oxygen, while partial success was considered if SpO2 improved from baseline but still required oxygen to achieve >94%. Secondary outcomes were an absolute improvement in SpO2 and sense of dyspnoea, without significant residual shunt on transthoracic echocardiography (TTE) at follow-up.

      Results

      Of 168 patients undergoing PFO or atrial septal defect closure, 14 had POS (8.3%). Percutaneous PFO closure was successfully performed in all patients with a single device. Twelve of 14 patients had total clinical success (86%) and one patient had partial success. The PaO2/FiO2 ratio increased from 155.9±50.6 to 318.3±73.4 after PFO closure (p=0.002). All patients with total clinical success had a successful secondary efficacy outcome with an absolute improvement in SpO2 and complete resolution of dyspnoea, which was maintained at follow-up (37±20 months; range, 11 months to 6 years). None had a significant residual shunt between 12 and 24 months of follow-up.

      Conclusion

      The PFO percutaneous closure was a successful, durable and safe method for patients presenting with POS; it achieved major improvements in both gasometrical parameters and quality of life.

      Keywords

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