Why the study?
PFO-associated platypnea-orthodeoxia syndrome is a rare and often underdiagnosed condition where percutaneous closure of the interatrial shunt is the preferred treatment.
Does percutaneous PFO closure improve orthostatic oxygen saturation and symptoms in patients with platypnea-orthodeoxia syndrome?
Does percutaneous PFO closure improve orthostatic oxygen saturation and symptoms in patients with platypnea-orthodeoxia syndrome?
Percutaneous PFO closure is highly effective for treating platypnea-orthodeoxia syndrome, leading to immediate and sustained improvements in oxygenation and symptoms.
Hypothesis-generating for PFO closure in POS; prospective trials needed before practice change.
BACKGROUND: 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 (SO2) while supine. The preferred treatment is percutaneous closure of the interatrial shunt, although surgery may be necessary in complex cases. METHODS: 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. RESULTS: 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 SO2, with an average increase of +8.65% from baseline, along with marked symptom resolution that persisted at 6-month follow-up. CONCLUSIONS: 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.
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Muro et al. (2025) studied this question.
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