Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Septo Interatrial/anatomia & histologia , Forame Oval Patente/complicações , Forame Oval Patente/etiologia , Síndrome de Platipneia Ortodeoxia/congênito , Procedimentos Cirúrgicos Cardiovasculares/instrumentação , Cateterismo/métodos , Ecocardiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Ecocardiografia Transesofagiana/métodos , Eletrocardiografia/métodos , Cardiopatias Congênitas/diagnóstico por imagemRESUMO
Platypnea-orthodeoxia syndrome (POS) is an uncommon syndrome characterized by dyspnea and hypoxemia triggered by orthostatism and relieved by recumbency. It is often associated with an interatrial shunt through a patent foramen ovale (PFO). We report the case of a 92-year-old woman initially admitted in the setting of a traumatic femoral neck fracture (successfully treated with hip replacement surgery) in whom a reversible decline in transcutaneous oxygen saturation from 98% (in the supine position) to 84% (in the upright position) was noted early post-operatively. Thoracic multislice computed tomography excluded pulmonary embolism and severe parenchymal lung disease. The diagnosis of POS was confirmed by tilt-table contrast transesophageal echocardiography, which demonstrated a dynamic and position-dependent right-to-left shunt (torrential when semi-upright and minimal in the supine position) through a PFO. The patient underwent percutaneous closure of the PFO with an Amplatzer device, which led to prompt symptom relief and full functional recovery.
