Carrasquel-Alvarez Michelle, Quasem Khaleel, George Varun, Elisevich Lee, Mughal Majid
McLaren Greater Lansing, Lansing, Michigan, USA; Michigan State University, East Lansing, Michigan, USA.
McLaren Greater Lansing, Lansing, Michigan, USA; Michigan State University, East Lansing, Michigan, USA.
JACC Case Rep. 2025 Jul 30;30(21):104433. doi: 10.1016/j.jaccas.2025.104433. Epub 2025 Jun 27.
Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnea and hypoxia exacerbated by an upright position. It is often associated with intracardiac or pulmonary shunting.
An 82-year-old woman presented with increasing fatigue, dizziness, and worsening dyspnea on exertion for 1 month. She was hypoxic, requiring high-flow oxygen. Initial work-up, including imaging and right heart catheterization, revealed an aneurysmal interatrial septum with a right-to-left shunt through a patent foramen ovale (PFO). The patient underwent successful percutaneous closure of the PFO, resulting in resolution of hypoxia and dyspnea.
POS should be suspected in cases of positional hypoxia. The pathophysiology involves anatomical and hemodynamic factors that promote right-to-left shunting in specific positions. PFO closure is the definitive treatment, leading to symptom resolution.
TAKE-HOME MESSAGES: POS should be considered in patients with unexplained positional hypoxia. PFO closure can significantly improve symptoms and quality of life in affected patients.