Platypnea-Orthodeoxia Syndrome

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Platypnea-orthodeoxia syndrome.

Q: What does this research mean for the field?

Platypnea-orthodeoxia syndrome represents a multifactorial continuum of dynamic right-to-left shunting rather than a condition restricted to rigid numerical thresholds, warranting dynamic physiological evaluation even when classical criteria are not strictly met. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tomohiro Kaneko; Eiichiro Sato; Nobuyuki Kagiyama

doi:10.1016/j.jaccas.2026.108898

July 1, 2026JACC Case ReportsOpen Access

Platypnea-Orthodeoxia Syndrome

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Key result

Platypnea-orthodeoxia syndrome should be viewed as a continuum of multiple interacting factors promoting dynamic right-to-left shunting rather than being defined by strict numerical thresholds.

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

Key Points

To evaluate the diagnostic criteria and pathophysiological mechanisms of dynamic right-to-left shunting across interatrial communications in platypnea-orthodeoxia syndrome.
Assessed a patient with suspected platypnea-orthodeoxia syndrome using physiological maneuvers combined with invasive hemodynamic evaluation to characterize dynamic right-to-left shunting.
Reviewed diagnostic performance of provocative testing, including the Valsalva maneuver, abdominal compression, and exercise, compared with static supine versus upright measurements.
Noted that rigid physiological thresholds, including an oxygen saturation decrease >5% or an arterial oxygen tension reduction >4 mm Hg upon standing, may fail to capture clinically significant dynamic right-to-left shunting.
Demonstrated that congenital interatrial communications, such as a patent foramen ovale or atrial septal aneurysm, can become symptomatic later in life through interactions with anatomical remodeling and dynamic preload shifts.
Concluded that the decision to close an interatrial defect should rely on overall clinical context and the magnitude of shunting rather than adherence to strict diagnostic cutoffs.

PICO

P

Population

Platypnea-orthodeoxia syndrome

Limitations

Current diagnostic definitions rely on rigid numerical thresholds.
Static assessments like supine versus upright oxygen saturation or resting bubble studies may underestimate dynamic right-to-left shunting.

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Implication

Platypnea-orthodeoxia syndrome should be viewed as a dynamic, multifactorial continuum rather than being strictly defined by rigid physiological thresholds.

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Cite This Study

Kaneko et al. (2026) conducted an editorial in Platypnea-orthodeoxia syndrome. Platypnea-orthodeoxia syndrome should be viewed as a continuum of multiple interacting factors promoting dynamic right-to-left shunting rather than being defined by strict numerical thresholds.

synapsesocial.com/papers/6ad0fc513afa093ea9acfd29 https://doi.org/10.1016/j.jaccas.2026.108898

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Platypnea-Orthodeoxia Syndrome

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Key Points

PICO

Limitations

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Implication

Abstract

Discussion

Cite This Study

Platypnea-Orthodeoxia Syndrome

Figures

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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