DI Muro Francesca M, Compagnone Miriam, Santoro Giuseppe, Boccuzzi Giacomo G, Ielasi Alfonso, Viola Orazio, Martinucci Pietro, Della Valle Antonio, Nardi Giulia, Crociani Maria F, Ciardetti Niccolò, Stolcova Miroslava, Ristalli Francesca, Mattesini Alessio, DI Mario Carlo, Meucci Francesco
Unit of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy.
Unit of Cardiology, Morgagni Pierantoni Hospital, Forlì, Forlì-Cesena, Italy.
Minerva Cardiol Angiol. 2025 Jul 2. doi: 10.23736/S2724-5683.25.06841-3.
Patent foramen ovale (PFO)-associated platypnea-orthodeoxia syndrome (POS) is a rare and often underdiagnosed condition characterized by hypoxemia refractory to oxygen therapy and paroxysmal dyspnea in the upright position, with normal arterial oxygen saturation (SO
This retrospective multicenter study included patients diagnosed with POS undergoing percutaneous PFO closure between 2020 and 2024 across eight tertiary Italian hospitals. We analyzed clinical characteristics, septal morphology, procedural details, as well as in-hospital and short-term clinical outcomes.
A total of 48 patients (56.3% female; mean age 75.4±9.8 years) were included. Pre-procedural echocardiography revealed complex interatrial septal (IAS) anatomy, with a significant proportion of patients presenting with IAS aneurysms and relatively large PFOs. The most frequently selected devices were the Amplatzer PFO and Cardia Ultrasept PFO Occluder (31.3% and 37.5%, respectively), followed by the GORE GSO device (16.7%), achieving a 100% procedural success rate. Postprocedure, all patients demonstrated significant improvement in orthostatic SO
In conclusion, PFO-related POS is often associated with complex IAS anatomy, including septal aneurysms and wider PFO tunnels. In such cases, larger and more flexible devices should be preferred for better adaptation to the unique septal structures and to obtain immediate and sustained improvements in oxygenation and symptoms. These findings emphasize the critical role of individualized device selection and procedural planning in optimizing outcomes for this challenging patient population.
卵圆孔未闭（PFO）相关的平卧呼吸-直立性低氧血症综合征（POS）是一种罕见且常被漏诊的疾病，其特征为氧疗难以纠正的低氧血症以及直立位时的阵发性呼吸困难，而仰卧位时动脉血氧饱和度（SO₂）正常。尽管在复杂病例中可能需要手术治疗，但首选治疗方法是经皮闭合房间隔分流。
这项回顾性多中心研究纳入了2020年至2024年间在意大利八家三级医院接受经皮PFO闭合术的POS诊断患者。我们分析了临床特征、间隔形态、手术细节以及住院期间和短期临床结局。
共纳入48例患者（女性占56.3%；平均年龄75.4±9.8岁）。术前超声心动图显示房间隔（IAS）解剖结构复杂，相当一部分患者存在IAS瘤和相对较大的PFO。最常选用的装置是Amplatzer PFO和Cardia Ultrasept PFO封堵器（分别占31.3%和37.5%），其次是GORE GSO装置（占16.7%），手术成功率达100%。术后，所有患者的直立位SO₂均有显著改善，平均较基线增加+8.65%，同时症状明显缓解，且在6个月随访时仍持续存在。
总之，PFO相关的POS常与复杂的IAS解剖结构相关，包括间隔瘤和更宽的PFO通道。在这种情况下，应首选更大、更灵活的装置，以更好地适应独特的间隔结构，并使氧合和症状立即且持续改善。这些发现强调了个体化装置选择和手术规划在优化这一具有挑战性患者群体的治疗结局中的关键作用。
