Platypnea-Orthodeoxia After TAVI for Severe Aortic Regurgitation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe aortic regurgitation (n=1). Intervention: Transcatheter aortic valve implantation (TAVI) with JenaValve Trilogy. Primary outcome: Development of platypnea-orthodeoxia syndrome.

Q: What does this research mean for the field?

Transcatheter aortic valve implantation (TAVI) for severe aortic regurgitation can reduce left-sided filling pressures and unmask right-to-left shunting through a patent foramen ovale, leading to platypnea-orthodeoxia syndrome. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sabrina Kopp; Paul Stamm; Karl-Philip Rommel; Martin Geyer; Philipp Lurz; Florian Schlotter

doi:10.1016/j.jaccas.2026.108397

June 1, 2026JACC Case ReportsOpen Access

Platypnea-Orthodeoxia After TAVI for Severe Aortic Regurgitation

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Key result

Percutaneous PFO closure resolves platypnea-orthodeoxia syndrome unmasked by TAVI for aortic regurgitation.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

TAVI is increasingly used in selected high-risk patients with severe native aortic regurgitation, but postprocedural hemodynamic changes may cause unexpected complications.

Key Points

To identify and manage the cause of refractory position-dependent hypoxemia following transcatheter aortic valve implantation for severe aortic regurgitation.
Clinical and echocardiographic assessment of an 82-year-old female presenting with severe native aortic regurgitation and septal hypertrophy undergoing transcatheter aortic valve implantation with a 23 mm JenaValve Trilogy prosthesis.
Workup of postprocedural refractory hypoxemia using transesophageal echocardiography and subsequent percutaneous closure using a 25/18 mm Amplatzer Talisman occluder.
Following valve replacement and pacemaker insertion for complete heart block, the patient developed platypnea-orthodeoxia syndrome with posture-dependent desaturation (upright SpO2 86%, PaO2 47 mm Hg vs supine SpO2 91%, PaO2 65 mm Hg).
Transesophageal echocardiography revealed a patent foramen ovale with spontaneous right-to-left shunting triggered by altered ventricular loading and hypercontractility.
Percutaneous closure restored oxygenation, with 1-month follow-up showing no residual interatrial shunt and a transaortic gradient of 11/6 mm Hg.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

An 82-year-old woman with severe aortic regurgitation who underwent transcatheter aortic valve implantation and developed new-onset postprocedural hypoxemia.

I

Intervention

Transcatheter aortic valve implantation (TAVI) using JenaValve Trilogy 23 mm, complicated by complete AV block requiring permanent dual-chamber pacemaker, and subsequent percutaneous patent foramen ovale (PFO) closure using an Amplatzer Talisman 25/18 mm device.

O

Outcome

Resolution of platypnea-orthodeoxia syndrome and hypoxemia

New-onset hypoxemia following TAVI for severe aortic regurgitation may be caused by platypnea-orthodeoxia syndrome from unmasked right-to-left shunting across a patent foramen ovale, a complication driven by altered ventricular loading.

Limitations

Single case report
Limited data exist regarding complications, long-term outcomes, and device durability in patients with aortic regurgitation undergoing TAVI compared to those with aortic stenosis

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Implication

Post-TAVI hypoxemia in AR may reflect unmasked PFO shunting; this single case leaves open whether preprocedural PFO screening improves outcomes.

Abstract

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is increasingly used in selected high-risk patients with severe native aortic regurgitation (AR). Postprocedural hemodynamic changes may cause unexpected complications. CASE SUMMARY: An 82-year-old woman underwent TAVI (JenaValve Trilogy 23 mm) for severe AR. She developed refractory hypoxemia due to platypnea-orthodeoxia syndrome from a patent foramen ovale (PFO) with right-to-left shunting. Percutaneous PFO closure (25/18 mm Amplatzer Talisman) restored oxygenation, and she was discharged in stable condition. DISCUSSION: AR correction alters ventricular loading and may reduce left-sided filling pressures, unmasking interatrial shunting, particularly in patients with preserved systolic function and septal hypertrophy. TAKE-HOME MESSAGE: Given the high prevalence of PFO, TAVI for AR may unmask right-to-left shunting, and platypnea-orthodeoxia syndrome should be considered in new-onset postprocedural hypoxemia.

Discussion

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Cite This Study

Kopp et al. (2026) conducted a case report in Severe aortic regurgitation (n=1). Transcatheter aortic valve implantation (TAVI) with JenaValve Trilogy was evaluated on Development of platypnea-orthodeoxia syndrome. Transcatheter aortic valve implantation for severe aortic regurgitation unmasked a patent foramen ovale resulting in platypnea-orthodeoxia syndrome, which was resolved by percutaneous closure.

synapsesocial.com/papers/6a53427374fa1c8297f17207 https://doi.org/10.1016/j.jaccas.2026.108397

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Platypnea-Orthodeoxia After TAVI for Severe Aortic Regurgitation

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Platypnea-Orthodeoxia After TAVI for Severe Aortic Regurgitation

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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