SPC365

Clinical and echocardiographic features of platypnea-orthodeoxia syndrome: a single-centre experience

Session: Posters (Sessão 6 - Écran 5) - Imagem 4 - Ecocardiografia 2
Speaker: Inês Fialho

Congress: CPC 2022
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Inês Fialho; Mariana Passos; Joana Lima Lopes; Carolina Mateus; Marco Beringuilho; João Baltazar Ferreira; Hilaryano Ferreira; José Morais; António Freitas; Carlos Morais

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Background:</span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> Platypnea-orthodeoxia syndrome (POS) is an uncommon condition characterized by dyspnoea and hypoxemia in the upright position that improves with recumbency. &nbsp;Echocardiography (TTE) is the cornerstone for POS diagnosis. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Purpose:</span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> To evaluate the clinical characteristics of patients presenting with POS.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Methods:</span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> We performed a single-centre retrospective analysis of patients diagnosed with POS between January 2015 and June 2021. Clinical presentation, blood tests, TTE information, and patent foramen ovale (PFO) closure procedure details were recorded.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Results</span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">:<strong>&nbsp;</strong>Seven&nbsp;patients were included, 86% female (n=6), median age 78 (72-85) years. The median age was 78 (72-85) years. The most prevalent cardiovascular risk factors were arterial hypertension (100%, n=7) and overweight/obesity (85.7%, n=6). Two patients (28.6%) had chronic pulmonary disease. The most common symptom was fatigue and exercise intolerance (n= 5, 71.4%) and the most frequent sign was persistent hypoxemia (n=7, 100%), although 28.6% (n=2) patients did not present the typical positional changes in peripheral oxygen saturation. Haemoglobin levels [14.1 (13.3-15.2) g/dL] were normal and NTproBNP levels [656 (287-1196) ng/dL] were slightly elevated. Right ventricle (RV) morphology and function were normal in 86% (n=6), low probability of pulmonary hypertension was found in 86% (n=6), and exuberant Eustachian valve was observed in 14% (n=1). All patients presented atrial septal hypermobility, 86% (n=6) with atrial septal aneurysm criteria. PFO was found in 86% (n=6) and ostium secundum ASD in 14% (n=1). POS precipitating factors were aortic root dilation (29%; n=2), chest trauma (14%; n=1), right hip arthroplasty (14%; n=1), atrial septal stretching regarding RV volume overload (14%; n=1). The underlying mechanism was unknown in 29% (n=2). ASD closure was performed in 57% (n=4) of patients with clinical improvement in all. No acute complications were found, except for paroxysmal atrial fibrillation (14%; n=1).</span></span></span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Conclusion</span></span></strong><span style="font-size:10pt"><span style="color:#000000"><span style="font-family:Arial,sans-serif">: POS diagnosis depends on high clinical suspicion: the most common manifestations are fatigue and persistent hypoxemia. Typical positional changes in oxygen saturation could be absent. Polycythaemia, RV dilation, and pulmonary hypertension are not common.</span></span></span></p>

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