Platypnea-orthodeoxia due to osteoporosis and severe kyphosis: a rare cause for dyspnea and hypoxemia
Abstract
Overview
Platypnea orthodeoxia is a rare disorder
characterized by dyspnea and arterial desaturation,
exacerbated by the upright position
and relieved when the subject is recumbent.
We report the case of a 79-year old woman
admitted to hospital with dyspnea who was
thought to have restrictive ventilatory impairment
due to osteoporosis and severe kyphosis.
Interestingly, the dyspnea was aggravated in
the upright position, whereas the symptoms
improved in the supine position. Arterial blood
gas analysis confirmed orthodeoxia. The lung
function test showed only a mild obstructive
and restrictive ventilation disorder.
Echocardiography revealed a patent foramen
ovale and an aneurysm of the atrial septum
protruding into the left atrium, despite normal
right atrial pressure. Transesophageal
echocardiography showed a prominent
Eustachian valve guiding a blood flow from the
inferior vena cava directly onto the atrial septum,
thereby pushing open the patent foramen
ovale. Contrast-enhanced echocardiography
confirmed a spontaneous right-to-left shunt
through the patent foramen ovale. It was
assumed that the platypnea-orthodeoxia was
caused by a prominent Eustachian valve redirected
to the patent foramen ovale as a result
of severe osteoporosis with subsequent thoracic
kyphosis and a change in the position of
the entire heart. The patient underwent permanent
transcatheter closure of the patent
foramen ovale after hemodynamic assessment
had confirmed a significant right-to-left shunt
through it. After the procedure the arterial
oxygen pressure increased significantly in the
upright position and dyspnea improved.
Keywords
Patent foramen ovale, orthodeoxia, platypnea, kyphosis, transcatheter closure.
Article Information
Correspondence
Claudius H.J. Teupe, MD, PhD, Krankenhaus Sachsenhausen Teaching Hospital, Goethe-University Frankfurt, Schulstrasse 31, D-60594 Frankfurt, Germany. E-mail: teupe@em.uni-frankfurt.de
Received
2011-06-23T00:00:00
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