ABSTRACT
Platypnea-orthodeoxia syndrome is a rare disorder characterized by dyspnea and oxygen desaturation in upright position, with improvement of symptoms and blood oxygenation in supine position. Basically a right-to-left shunt (intracardiac or pulmonary) or a ventilation/perfusion mismatch are necessary to develop platypnea-orthodeoxia syndrome. Atrial septal defects, including patent foramen ovale (PFO), are known to be a frequent cause of platypnea-orthodeoxia syndrome. We describe herein the case of a 79-year-old woman with platypnea-orthodeoxia syndrome and PFO who developed a refractory worsening respiratory failure. Only the "rescue" emergency closure of PFO allowed the patient a clinical turning point with immediate and sustained respiratory improvement.
Subject(s)
Dyspnea/etiology , Foramen Ovale, Patent/complications , Hypoxia/etiology , Respiratory Insufficiency/etiology , Acute Disease , Aged , Female , Foramen Ovale, Patent/surgery , Humans , Patient Positioning , Respiratory Insufficiency/surgery , SyndromeABSTRACT
AIMS: Transcatheter aortic valve implantation has become an established treatment for severe aortic stenosis, thanks to key improvements achieved by new-generation devices. Their comparative effectiveness and safety are, however, still uncertain. METHODS: We queried a prospective registry on transcatheter aortic valve implantation to compare Evolut and Portico devices, focusing on procedural, in-hospital, and mid-term outcomes. Unadjusted and propensity-adjusted analyses were carried out. RESULTS: In all, 233 patients were included, 119 (51.1%) receiving Evolut and 114 (48.9%) Portico. Several differences in baseline and procedural features were evident, including comorbidities, device size, and postdilation (all Pâ<â0.05). Unadjusted analysis for procedural results showed significant differences in fluoroscopy time, left ventricular ejection fraction, and aortic regurgitation (all Pâ<â0.05), whereas device and procedural success rates were not significantly different (both Pâ>â0.05). In-hospital outcomes were not significantly different (all Pâ>â0.05). Survival analysis for mid-term follow-up (6â±â7 months) outcomes showed no significant differences in death, stroke, myocardial infarction, major vascular complication, or major bleeding (all Pâ>â0.05). Conversely, Evolut appeared associated with lower peak and mean aortic gradients (both Pâ<â0.05), but higher rate of permanent pacemaker implantation (Pâ=â0.043). Propensity-score-adjusted analysis largely confirmed the similar performance of the two devices, including peak and mean aortic gradients (both Pâ>â0.05). However, Evolut continued to be associated even at adjusted analysis with an increased risk of pacemaker implantation (Pâ=â0.018). CONCLUSION: The acute and mid-term comparative safety and effectiveness of Evolut and Portico in experienced hands are similar, with the notable exception of a lower risk of permanent pacemaker implantation with Portico.