Salazar Carlos, Majano Romeo A
Department of Internal Medicine, Weiss Memorial Hospital, 4646 N. Marine Drive, Chicago, IL 60640, USA.
Miami Cardiac and Vascular Institute, South Miami Hospital, Baptist Health, 6200 SW 73 Street, South Miami, FL 33143, USA.
Case Rep Crit Care. 2017;2017:4397163. doi: 10.1155/2017/4397163. Epub 2017 Nov 28.
Platypnea orthodeoxia (PO) is an infrequent condition of dyspnea with hypoxemia, increased by adopting an upright position and is relieved in decubitus. This condition may occur in patients with hidden intracardiac shunts, usually across a persistent foramen ovale (PFO). The incidence of PFO in general population is quite common, around 27%; however, the concurrent presentation with PO, especially in acute refractory respiratory failure, is extremely rare. PFO closure in this setting is still the treatment of choice with significant improvement or complete resolution of symptoms after closure with an overall periprocedural complication in the first 24 hours of approximately less than 5%. A transient ST-segment elevation in the inferior leads is present in extremely rare occasions and most likely is induced by either an air embolism or a mechanically provoked spasm of coronary arteries. We report a case of an 83-year-old woman in acute hypoxic and refractory respiratory failure in whom PO was identified, most likely induced by a hidden PFO. The patient underwent percutaneous transcatheter closure and developed immediate chest pain, transient hemodynamic instability, and ST-segment elevation in the inferior leads; nevertheless, our patient recovered completely with rapid resolution of respiratory failure with no adverse clinical sequelae.
直立性呼吸困难-卧位性低氧血症（PO）是一种罕见的伴有低氧血症的呼吸困难病症，采取直立位时症状加重，卧位时缓解。这种情况可能发生在隐匿性心内分流患者中，通常是通过持续存在的卵圆孔未闭（PFO）。PFO在普通人群中的发生率相当常见，约为27%；然而，并发PO的情况，尤其是在急性难治性呼吸衰竭中，极为罕见。在这种情况下，PFO封堵仍是首选治疗方法，封堵后症状可显著改善或完全缓解，围手术期最初24小时的总体并发症发生率约低于5%。极罕见情况下，下壁导联会出现短暂的ST段抬高，最可能是由空气栓塞或冠状动脉机械性诱发痉挛所致。我们报告一例83岁女性急性缺氧和难治性呼吸衰竭患者，该患者被诊断为PO，最可能由隐匿性PFO引起。患者接受了经皮导管封堵术，术后立即出现胸痛、短暂的血流动力学不稳定以及下壁导联ST段抬高；尽管如此，我们的患者完全康复，呼吸衰竭迅速缓解，无不良临床后遗症。
