Platypnea-Orthodeoxia Syndrome Caused by Patent Foramen Ovale Successfully Treated With Percutaneous Closure

Visual Summary. Posture-Dependent Hypoxemia (SpO2: 80%-83% Upright vs 95%-99% Supine) in a 74-Year-Old Woman With Progressive Dyspnea Supine transesophageal echocardiography showed minimal shunting, whereas upright imaging revealed marked right-to-left flow through a patent foramen ovale with an atrial septal aneurysm. Percutaneous closure with a Gore Cardioform septal occluder abolished the shunt and normalized oxygenation, resulting in sustained symptomatic improvement. LA = left atrium; PFO = patent foramen ovale; RA = right atrium; SpO2 = peripheral oxygen saturation; TEE = transesophageal echocardiography.

Figure 1. Chest Radiograph and Computed Tomography (A) Posteroanterior chest radiograph showing mild cardiomegaly without apparent mediastinal widening. (B) Sagittal computed tomography demonstrating thoracic kyphosis and degenerative changes of the spine. (C and D) Coronal view and corresponding 3-dimensional reconstruction showing elongation and tortuosity of the ascending aorta compressing the right atrium. Ao = aorta; RA = right atrium.

Figure 2. Transesophageal Echocardiography Images (A and B) Supine transesophageal echocardiography showing an atrial septal aneurysm with minimal right-to-left shunting during the Valsalva maneuver and a weakly positive microbubble test. (C) Photograph demonstrating transesophageal echocardiography being performed in the sitting position. (D and E) Upright transesophageal echocardiography demonstrating marked leftward bowing of the interatrial septum (arrows) and prominent right-to-left shunting within 3 cardiac cycles after microbubble injection.