Article Text

Download PDFPDF
Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt following pneumonectomy
  1. Matthew Steward,
  2. Anthony Hall,
  3. Ross Sayers and
  4. Christopher Dickson
  1. Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  1. Correspondence to Dr Matthew Steward; matt.steward1{at}


A 62-year-old man presents with breathlessness 6 months following right pneumonectomy for lung adenocarcinoma. Previous investigations had not yielded a diagnosis and his symptoms were progressing. The patient described worsened symptoms when stood up (platypnoea), with profound hypoxia until laid supine (orthodeoxia). Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt was diagnosed on contrast-enhanced transoesophageal echocardiography with the patient undergoing successful percutaneous patent foramen ovale closure. Patent foramen ovale is often asymptomatic with a population prevalence of around 20%–30%. Anatomical shifts postpneumonectomy can open, or worsen a previously closed interatrial communication leading to right-to-left shunting of blood. Platypnoea-orthodeoxia is under-recognised, impairing quality of life and patient outcome. Investigations can be falsely reassuring, or poorly sensitive for the causative pathology. Percutaneous closure is safe with high success rates and this case highlights the need for a high index of suspicion for shunts, particularly in postpneumonectomy patients.

  • lung cancer (oncology)
  • cardiovascular medicine
  • respiratory medicine

Statistics from


  • Contributors MS contributed to the initial draft, editing and finalisation of the final manuscript. RS and CD contributed to editing the manuscript. AH contributed to conceptualisation, review of the final manuscript and approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.