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Platypnea-orthodeoxia syndrome in patent foramen ovale and fenestrated atrial septal aneurysm with normal right atrial pressure: what is the culprit?
  1. Jerald Pelayo1,
  2. Anum Shahzad2,
  3. Eric Peterson1 and
  4. Gregg Pressman2
  1. 1Internal Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
  2. 2Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Jerald Pelayo; pelayoje{at}


A 76-year-old Korean woman presented with intermittent episodes of exertional hypoxia at the rehabilitation facility after a recent admission for ischaemic stroke. Clinical and diagnostic investigation confirmed the presence of platypnea-orthodeoxia syndrome (POS). Transoesophageal echocardiogram revealed a patent foramen ovale and hyperdynamic interatrial septum with right-to-left intracardiac shunt. Further diagnostic workup did not reveal right atrial hypertension, cirrhosis, pulmonary hypertension or any other extracardiac causes of right-to-left shunt. Positional preferential blood flow from inferior vena cava to the left atrium due to counterclockwise displacement of interatrial septum with age and posture was postulated to explain the atrial right-to-left shunt and the resultant POS. Closure was performed using a cribriform amplatzer occluder which improved her symptoms.

  • interventional cardiology
  • radiology (diagnostics)
  • clinical diagnostic tests

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  • Contributors Dr Pelayo, Dr Shahzad and Dr Peterson conceived the idea of submitting this case report after being involved in taking care of this patient. Dr Pelayo wrote the manuscript with the supervision and guidance of Dr Shahzad and Dr Pressman.

  • 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.