Thoracic Surgery Department, "HYGEIA" Hospital, Athens, Greece.
Congenital Heart Disease Department, "MITERA" Hospital, Athens, Greece.
J Invest Surg. 2022 Jan;35(1):180-185. doi: 10.1080/08941939.2020.1825883. Epub 2020 Dec 2.
: Platypnoea-Orthodeoxia Syndrome is an uncommon phenomenon characterized by dyspnea/arterial desaturation in the standing position, resolving in recumbency. Some patients present with Platypnoea-Orthodeoxia Syndrome in the early-or-late post-operative period after major lung resection (lobectomy/pneumonectomy). The main cause of Platypnoea-Orthodeoxia Syndrome is an intracardiac anomaly (Patent Foramen Ovalis/Atrial Septal Defect) leading to right-to-left shunt.: To identify the causes of post-lobectomy Platypnoea-Orthodeoxia Syndrome, and the possible pathophysiologic mechanism. A Pubmed database-EMBASE systematic review was performed in order to find all reports, reporting the occurrence of dyspnea/hypoxemia after lobectomy.: 8 studies were found concerning ten patients during the period from 1983-2019.There was 6 male/4 female. The mean age was 62 years. All patients underwent resection of the right lung. The time-interval between the operation and the Platypnoea-Orthodeoxia Syndrome was from 2 days to 3 years. A Patent Foramen Ovalis was present in 90% and in 10% an Atrial Septal Defect was diagnosed. The mean Right Atrial Pressure was 7.5 mmHg, the mean Left Atrial Pressure was 6.6 mmHg and the mean Pulmonary artery pressure was 18.5 mmHg. The mean size of the interatrial communication was 1.62 cm. The inter-atrial communication was closed by open-chest surgical procedure in 3 cases (30%) and in 7 patients (70%) a percutaneous transcatheter device was implanted.: Platypnoea-Orthodeoxia Syndrome after lobectomy is a rare cause of post-operative dyspnea/hypoxia. It is the result of right-to-left shunt via an interatrial communication. Mediastinal relocation, stretching of the atrial septum and aortic root dilatation are among the functional elements necessary for the Platypnoea-Orthodeoxia Syndrome manifestation.
直立性呼吸困难-低氧血症综合征是一种不常见的现象，其特征是在直立位时出现呼吸困难/动脉血氧饱和度降低，而在卧位时缓解。一些患者在肺切除术后（肺叶切除术/全肺切除术）的早期或晚期出现直立性呼吸困难-低氧血症综合征。直立性呼吸困难-低氧血症综合征的主要原因是心内异常（卵圆孔未闭/房间隔缺损）导致右向左分流。为了确定肺叶切除术后直立性呼吸困难-低氧血症综合征的原因，并探讨可能的病理生理机制。我们进行了 Pubmed 数据库-EMBASE 系统评价，以查找所有报告，报告肺叶切除术后出现呼吸困难/低氧血症的病例。在 1983 年至 2019 年期间，共发现 8 项研究涉及 10 例患者。其中 6 例为男性，4 例为女性。平均年龄为 62 岁。所有患者均接受了右肺切除术。手术与直立性呼吸困难-低氧血症综合征之间的时间间隔为 2 天至 3 年。90%的患者存在卵圆孔未闭，10%的患者诊断为房间隔缺损。平均右心房压力为 7.5mmHg，平均左心房压力为 6.6mmHg，平均肺动脉压力为 18.5mmHg。房间隔缺损的平均直径为 1.62cm。3 例（30%）通过开胸手术关闭房间隔缺损，7 例（70%）患者通过经皮导管植入装置关闭房间隔缺损。肺叶切除术后直立性呼吸困难-低氧血症综合征是术后呼吸困难/低氧血症的罕见原因。其是通过房间隔缺损导致右向左分流的结果。纵隔移位、房间隔伸展和主动脉根部扩张是直立性呼吸困难-低氧血症综合征表现所必需的功能性因素。
