Open AccessPlatypnea Orthodeoxia Syndrome Secondary to Intracardiac Shunt Following Orthotopic Liver Transplantation
Author(s) -
Sophia Larson,
Philip Vutien,
Zachary L. Steinberg
Publication year - 2020
Publication title -
journal of investigative medicine high impact case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.247
H-Index - 10
ISSN - 2324-7096
DOI - 10.1177/2324709620925575
Subject(s) - medicine , patent foramen ovale , intracardiac injection , hepatopulmonary syndrome , shunting , shunt (medical) , inferior vena cava , cardiology , right to left shunt , liver transplantation , transplantation , surgery , percutaneous
Platypnea orthodeoxia syndrome (POS) occurs when an upright position results in acute-onset hypoxemia and is relieved with recumbency. POS can be due to intracardiac shunting, intrapulmonary shunting, ventilation-perfusion mismatch, or a combination of these. We report a case of POS that developed 3 days post liver transplantation as a result of new-onset right to left shunting across a patent foramen ovale. Right heart catheterization revealed a posteriorly directed inferior vena cava likely due to altered inferior vena cava—right atrial junction anatomy as a result of liver transplantation. The patient underwent successful transcatheter patent foramen ovale closure with a 25-mm Gore Cardioform septal occluder device with immediate and sustained improvement in hypoxia.