AN INSIDIOUS CASE OF DYSPNEA: THE CHALLENGE OF EXPLORING A TUNNEL

• DOI: 10.1093/eurheartjsupp/suaf076.196
• Publication Date: 2025-05-15T11:49:18Z
• Authors: M De Pietri; M Colletta; K Hoxha; G Forasassi; E Perugini; G Casella

Abstract First described in the mid–20th century, platypnea–orthodeoxia syndrome (POS) is a rare condition characterized by positional shortness of breath and low blood oxygen levels. These features are triggered standing alleviated clinostatism. It most often linked to right–to–left shunting through patent foramen ovale (PFO) or atrial septal defect, although its exact pathophysiology not fully understood. Due rarity, POS frequently underdiagnosed many patients. The relationship between PFO occurrence this may be influenced aging–related factors such as aortic root dilation, size, projecting Eustachian valve (›10 mm), kyphoscoliosis (which distorts interatrial septum), right ventricular stiffness. Percutaneous closure subgroup patients recommended, even though approximately only 200 cases have been since first case was reported. crucial perform rigorous follow–up, especially presenting these risk factors, which represent strong predictors recurrence short long–term complications. We report 78 years old woman that illustrates challenge diagnosis second faces therapeutic follow–up approach. This patient presented with history previous multiple cryptogenic strokes, recent myocardial infarction without any evidence biventricular dysfunction. She refractory hypoxemia, showing several episodes significant desaturation occurred she an upright position, but were resolved upon repositioning recumbent posture, confirmed gas analysis. raised suspicion syndrome, reinforced positive transcranial doppler. A transesophageal echocardiogram (TEE) conducted lying flat revealed hypermobile intra–atrial septum large (figures 1, 2, 3) necessitating defect. Our underwent successful percutaneous communication (device 30–mm Gore Cardioform occluder), no residual shunting, clinical improvement, hypoxemia. Starting from we will illustrate understanding mechanism results symptoms. also focus on treatment possibilities according recurrence, subtypes population certain anatomical factors.Fig. 1 Fig. 2 3