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Platypnea‐orthodeoxia: Management by transcatheter buttoned device implantation
Author(s) -
Rao P. Syamasundar,
Palacios Igor F.,
Bach Richard G.,
Bitar Saad R.,
Sideris Eleftherios B.
Publication year - 2001
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.1243
Subject(s) - medicine , patent foramen ovale , hypoxemia , occlusion , shunt (medical) , surgery , cardiology , air embolism , foramen secundum , right to left shunt , paradoxical embolism , heart septal defect , complication , percutaneous
Dyspnea and arterial desaturation on upright position in elderly subjects is described as platypnea‐orthodeoxia syndrome (POS) and in some patients it is due to right‐to‐left shunt across the atrial septal defect (ASD)/patent foramen ovale (PFO). Surgical closure of ASD/PFO has been the only available treatment option. Buttoned device has been used for occlusion of ostium secundum ASD, PFO associated with presumed paradoxical embolism and cerebrovascular accidents and ASD/PFO in association with other congenital heart defects causing right‐to‐left shunt. The objective of this article is to describe the use of buttoned device in effectively occluding ASD/PFO to relieve hypoxemia of POS. During a 4‐year period ending January 2000, 10 patients, ages 71 ± 9 (range 60–83) years with POS underwent buttoned device closure of their ASD/PFO. Echocardiographic and balloon‐stretched atrial defect sizes were 8 ± 3 mm and 12 ± 3 mm, respectively. The ASD/PFO were occluded with devices ranging in size from 25 to 40 mm delivered via 9 French, long, blue Cook sheaths; eight had an additional 25‐ or 35‐mm occluder placed on the right atrial side. The oxygen saturation increased ( P < 0.001) from 76 ± 7% (range 69–86%) to 95 ± 2% (range 92–98%). No complications were encountered. Relief of symptoms was seen in all patients. Follow‐up of 1–36 months (median 12 months) revealed persistent improvement of symptoms. Buttoned device occlusion of ASD/PFO to relieve hypoxemia of POS is feasible, safe, and effective and is an excellent alternative to surgery. Cathet Cardiovasc Intervent 2001;54:77–82. © 2001 Wiley‐Liss, Inc.