What question did this study set out to answer?

This research aims to evaluate the impact of patent foramen ovale on refractory hypoxemia in patients experiencing platypnea-orthodeoxia syndrome.

June 23, 2026Open Access

Refractory Hypoxemia Secondary to Patent Foramen Ovale Presenting With Platypnea-Orthodeoxia Syndrome

Key Points

This research aims to evaluate the impact of patent foramen ovale on refractory hypoxemia in patients experiencing platypnea-orthodeoxia syndrome.
Described a case of a 59-year-old woman with chronic hypoxemic respiratory failure and worsening oxygenation.
Conducted comprehensive evaluations to rule out primary pulmonary, vascular, and parenchymal causes.
Utilized contrast echocardiography to confirm right-to-left shunting through the patent foramen ovale and performed percutaneous closure.
Immediate improvement in oxygenation post-percutaneous closure with liberation from supplemental oxygen.

Abstract

Patent foramen ovale (PFO) is a common congenital cardiac anomaly present in 20%-25% of adults and is usually clinically silent. In rare cases, it can result in significant right-to-left shunting and refractory hypoxemia, particularly in platypnea-orthodeoxia syndrome (POS). We describe a 59-year-old woman with chronic hypoxemic respiratory failure who developed worsening oxygenation despite high-flow supplemental oxygen. Comprehensive evaluation excluded primary pulmonary, vascular, and parenchymal etiologies. Contrast echocardiography demonstrated a PFO with early right-to-left shunting. Percutaneous closure resulted in immediate and sustained improvement in oxygenation, with liberation from supplemental oxygen.

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