Chest
Volume 100, Issue 4, October 1991, Pages 1157-1158
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Patent Foramen Ovale Associated with Platypnea and Orthodeoxia

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A case of positionally symptomatic right-to-left shunting across a patent foramen ovale with both platypnea and orthodeoxia despite normal pulmonary arterial pressures and normal right ventricular function is documented. When the patient was in a supine position, the calculated right-to-left shunt was 12.8 percent, and when seated 25 percent. Surgical closure of the patent foramen ovale relieved the symptoms and positionally induced shunting. The prevalence and associations of permanent and intermittent patency of the foramen ovale are discussed. It is recommended that those at risk of thromboembolism be screened for patency by contrast ultrasound or color flow techniques. If present, surgical closure needs to be considered to prevent paradoximal embolism and stroke.

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CASE REPORT

A 70-year-old white woman had been in good health until one year prior to presentation when she noted fatigue during physical activity. This had now become progressive; very slight physical effort was associated with severe breathlessness requiring her to sit or lie down to regain her breath. During an airplane flight, acute breathlessness occurred. Since the patient already knew that lying flat caused her acute symptoms to resolve, her condition improved while lying horizontal in an ambulance

DISCUSSION

This report documents a 70-year-old woman who had platypnea and orthodeoxia caused by right-to-left shunting across a patent foramen ovale, even though pulmonary artery pressures and right heart function were normal. In the absence of lung disease, platypnea and orthodeoxia are very unusual occurrences, since it is the associated lung disease that enhances a tendency for right-to-left shunting across a patent foramen ovale.4

The true incidence of patency of the foramen ovale is unknown. Autopsy

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