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PFO closure resolves postural dyspnea, hypoxemia in platypnea-orthodeoxia syndrome
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Closure of a patent foramen ovale resolved symptoms of postural dyspnea and hypoxemia and was effective for treating platypnea-orthodeoxia syndrome, except for situations in which hypoxemia is related to a pulmonary origin, according to recent findings in Catheterization and Cardiovascular Interventions.
“In patients with platypnea-orthodeoxia [syndrome] who have a large intracardiac [right to left] shunt, successful closure of the PFO may resolve symptomatic postural dyspnea and profound hypoxemia,” the researchers wrote.
Mohammad Khalid Mojadidi, MD, of the department of internal medicine at Albert Einstein College of Medicine and Jacobi Medical Center in New York, and colleagues prospectively identified patients with a PFO and platypnea-orthodeoxia syndrome who were referred to the University of California, Los Angeles, from 2001 to 2012. Patients who chose to have the PFO closed were examined to determine symptom severity and changes in interval oxygen saturation (SaO2). Evaluations were performed with patients in both the supine and upright positions, as platypnea-orthodeoxia syndrome improves in the supine position, according to the researchers. Patients were classified after PFO closure based on whether SaO2 improved or did not change.
Of the initial pool of 683 patients with PFO-associated conditions, 17 patients (2.5%) with platypnea-orthodeoxia syndrome chose to have the PFO closed; 11 (64.8%) had improved SaO2. These patients experienced improvement or complete resolution of dyspnea and hypoxemia (improved SaO2 from baseline, 5.2 ± 4.7% in the recumbent position and 15.6 ± 3% in the upright position; P = .03 and P < .0001, respectively).
Patients who experienced no change in SaO2 after PFO closure primarily had hypoxia with a pulmonary etiology and increased mean pulmonary pressures before closure (51.4 ± 16.8 mm Hg; P = .06). – by Julia Ernst, MS
Disclosure: Mojadidi reports no relevant financial disclosures. The study was funded by St. Jude Medical, which provided the transcranial Doppler system. Please see the full study for a list of all other authors’ relevant financial disclosures.
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