دورية أكاديمية
Platypnea-Orthodeoxia Syndrome: To Shunt or Not to Shunt, That is the Question.
| العنوان: | Platypnea-Orthodeoxia Syndrome: To Shunt or Not to Shunt, That is the Question. |
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| المؤلفون: | Klein MR, Kiefer TL, Velazquez EJ |
| المصدر: | Texas Heart Institute journal [Tex Heart Inst J] 2016 Jun 01; Vol. 43 (3), pp. 264-6. Date of Electronic Publication: 2016 Jun 01 (Print Publication: 2016). |
| نوع المنشور: | Case Reports; Journal Article; Review |
| اللغة: | English |
| بيانات الدورية: | Publisher: published in the Cardiovascular Surgical Research Laboratories, Texas Heart Institute Country of Publication: United States NLM ID: 8214622 Publication Model: eCollection Cited Medium: Internet ISSN: 1526-6702 (Electronic) Linking ISSN: 07302347 NLM ISO Abbreviation: Tex Heart Inst J Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Houston, TX : published in the Cardiovascular Surgical Research Laboratories, Texas Heart Institute, c1982- |
| مواضيع طبية MeSH: | Decision Making*, Cardiac Surgical Procedures/*methods , Dextrocardia/*complications , Dyspnea/*etiology , Foramen Ovale, Patent/*complications , Heart Septal Defects, Atrial/*complications , Hypoxia/*etiology, Aged ; Cardiac Catheterization ; Dextrocardia/diagnosis ; Dextrocardia/surgery ; Dyspnea/diagnosis ; Dyspnea/surgery ; Female ; Foramen Ovale, Patent/diagnosis ; Foramen Ovale, Patent/surgery ; Humans ; Hypoxia/diagnosis ; Hypoxia/surgery ; Syndrome |
| مستخلص: | Platypnea-orthodeoxia syndrome is a rare disease defined by dyspnea and deoxygenation, induced by an upright position, and relieved by recumbency. Causes include shunting through a patent foramen ovale and pulmonary arteriovenous malformations. A 79-year-old woman experienced 2 syncopal episodes at rest and presented at another hospital. In the emergency department, she was hypoxic, needing 6 L/min of oxygen. Her chest radiograph showed nothing unusual. Transthoracic echocardiograms with saline microcavitation evaluation were mildly positive early after agitated-saline administration, suggesting intracardiac shunting. She was then transferred to our center. Right-sided heart catheterization revealed no oximetric evidence of intracardiac shunting while the patient was supine and had a low right atrial pressure. However, her oxygen saturation dropped to 78% when she sat up. Repeat transthoracic echocardiography while sitting revealed a dramatically positive early saline microcavitation-uptake into the left side of the heart. Transesophageal echocardiograms showed a patent foramen ovale, with right-to-left shunting highly dependent upon body position. The patient underwent successful percutaneous patent foramen ovale closure, and her oxygen supplementation was suspended. In patients with unexplained or transient hypoxemia in which a cardiac cause is suspected, it is important to evaluate shunting in both the recumbent and upright positions. In this syndrome, elevated right atrial pressure is not necessary for significant right-to-left shunting. Percutaneous closure, if feasible, is first-line therapy in these patients. |
| References: | Cardiology. 2012;123(1):15-23. (PMID: 22948714) Circulation. 2001 Aug 7;104(6):741. (PMID: 11489786) Chest. 2000 Aug;118(2):553-7. (PMID: 10936158) Cardiovasc Intervent Radiol. 2005 Mar-Apr;28(2):164-8. (PMID: 15719178) Catheter Cardiovasc Interv. 2001 Sep;54(1):77-82. (PMID: 11553954) J Invasive Cardiol. 2004 Oct;16(10 ):578-82. (PMID: 15505355) |
| فهرسة مساهمة: | Keywords: Congenital heart defects; dyspnea/diagnosis/radiography/therapy; echocardiography, transesophageal/color-flow; foramen ovale, patent; heart septal defects, atrial/ultrasonography; hypoxemia; magnetic resonance imaging, cardiac/cine; oxygen/blood; posture; respiration insufficiency/etiology |
| تواريخ الأحداث: | Date Created: 20160616 Date Completed: 20170615 Latest Revision: 20181113 |
| رمز التحديث: | 20240628 |
| مُعرف محوري في PubMed: | PMC4894711 |
| DOI: | 10.14503/THIJ-15-5280 |
| PMID: | 27303248 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1526-6702 |
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| DOI: | 10.14503/THIJ-15-5280 |