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Transcatheter Closure of Patent Foramen Ovale in Patients with Platypnea-Orthodeoxia: Results of a Multicentric French Registry

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Abstract

Background

Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO).

Methods

This French multicentric study reports on 78 patients (mean age 67 ± 11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n = 36) and an ascending aortic aneurysm (n = 11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n = 45), Cardioseal (n = 13), Sideris (n = 11), Das Angel Wings (n = 8) and Starflex (n = 1). Closure was successful in 76 patients (97%).

Results

Oxygen saturation increased immediately after occlusion from 84.6 ± 10.7% to 95.1 ± 6.4% (p < 0.001) and dyspnea improved from grade 2.7 ± 0.7 to grade 1 ± 1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15 ± 12 months, there were 7 late deaths related to the underlying disease.

Conclusion

Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.

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References

  1. JB Seward DL Hayes HC Smith DE Williams EC Rosenow GS Reeder JM Piehler AJ Tajik (1984) ArticleTitlePlatypnea-orthodeoxia: Clinical profile, diagnostic workup, management, and report of seven cases Mayo Clin Proc 59 221–231 Occurrence Handle1:STN:280:DyaL2c7ms1GktA%3D%3D Occurrence Handle10.1016/S0025-6196(12)61253-1

    Article  CAS  Google Scholar 

  2. WJ Frank M Smenk PE Postmus (1993) ArticleTitleInteratrial right-to-left shunting developing after pulmonary resection in the absence of elevated right-sided, heart pressure. Review of the literature Chest 103 528–531 Occurrence Handle10.1378/chest.103.2.528

    Article  Google Scholar 

  3. R Begin (1975) ArticleTitlePlatypnea after pneumonectomy N Engl J Med 293 342–343 Occurrence Handle1:STN:280:DyaE2M3hs1emtA%3D%3D Occurrence Handle10.1056/NEJM197508142930707

    Article  CAS  Google Scholar 

  4. RM Springer M Gheorghiade CS Chakko GM Bell RO Cannon J Urquhart M Jones RO Bonow (1983) ArticleTitlePlatypnea and interatrial right-to-left shunting after lobectomy Am J Cardiol 51 1802–1803 Occurrence Handle1:STN:280:DyaL3s3islyqsQ%3D%3D Occurrence Handle10.1016/0002-9149(83)90238-2

    Article  CAS  Google Scholar 

  5. G Popp H Melek AR Garnett (1997) ArticleTitlePlatypnea-orthodeoxia related to aortic elongation Chest 112 1682–1684 Occurrence Handle1:STN:280:DyaK1c%2FmslaktA%3D%3D Occurrence Handle10.1378/chest.112.6.1682

    Article  CAS  Google Scholar 

  6. ME Gallaher DR Sperling JL Gwinn BW Meyer DC Fyler (1963) ArticleTitleFunctional drainage of the inferior vena cava into the left atrium. Three cases Am J Cardiol 12 561–566 Occurrence Handle1:STN:280:DyaF2c%2FisFSksw%3D%3D Occurrence Handle10.1016/0002-9149(63)90196-6

    Article  CAS  Google Scholar 

  7. TG Schnabel O Ratto CK Kirby J Johnson JM Comroe (1956) ArticleTitlePostural cyanosis and angina pectoris following pneumonectomy: Relief by closure of an interatrial septal defect J Thorac Surg 32 246–250 Occurrence Handle10.1016/S0096-5588(20)30418-9

    Article  Google Scholar 

  8. NC Bakris AJ Siddiqi CD, Fraser SuffixJr. AC Metha (1997) ArticleTitleRight to left interatrial shunt after pneumonectomy Ann Thorac Surg 63 198–201 Occurrence Handle1:STN:280:DyaK2s7ks1Cjuw%3D%3D Occurrence Handle10.1016/S0003-4975(96)01015-6

    Article  CAS  Google Scholar 

  9. ED Robin (1997) ArticleTitleAn analysis of platypnea-orthodeoxia syndrome including a “new” therapeutic approach Chest 112 1449–1451 Occurrence Handle1:STN:280:DyaK1c%2Fmslansg%3D%3D Occurrence Handle10.1378/chest.112.6.1449

    Article  CAS  Google Scholar 

  10. J Losay V Lambert ML Bourachot X Berthaud G Esna C Angel (1999) ArticleTitleFermeture percutannée des patent foramen ovale après pneumonectomie J Chir Thorac Cardiovasc 3 145–149

    Google Scholar 

  11. F Godart C Rey A Prat A Vincentelli A Chmaït C Francart H Porte (2000) ArticleTitleAtrial right-to-left shunting causing severe hypoxaemia despite normal right-sided pressures. Report of 11 consecutive cases corrected by percutaneous closure Eur Heart J 21 483–489 Occurrence Handle1:STN:280:DC%2BD3c7kvVGmtQ%3D%3D Occurrence Handle10.1053/euhj.1999.1944

    Article  CAS  Google Scholar 

  12. EA Adolph WO Lacy YI Hermoni LF Wexler S Javaheri (1992) ArticleTitleReversible orthodeoxia and platypnea due to right-to-left intracardiac shunting related to pericardial effusion Ann Intern Med 116 138–139 Occurrence Handle1:STN:280:DyaK38%2FovVWrsw%3D%3D Occurrence Handle10.7326/0003-4819-116-2-138

    Article  CAS  Google Scholar 

  13. B Wranne K Tolagen (1978) ArticleTitlePlatypnea after pneumonectomy caused by a combination of intracardiac right-to-left shunt and hypovolaemia. Relief of symptoms on restitution of blood volume Scand J Thorac Cardiovasc Surg 12 129–131 Occurrence Handle1:STN:280:DyaE1M%2FlsF2rtQ%3D%3D Occurrence Handle10.3109/14017437809100362

    Article  CAS  Google Scholar 

  14. KA Labresh DA Pietro EO Coates SF Khuri ED Folland AF Parisi (1981) ArticleTitlePlatypnea syndrome after left pneumonectomy Chest 79 605–607 Occurrence Handle1:STN:280:DyaL3M7oslGlsA%3D%3D Occurrence Handle10.1378/chest.79.5.605

    Article  CAS  Google Scholar 

  15. N Mercho JK Stoller RD White et al. (1994) ArticleTitleRight to left interatrial shunt causing platypnea after pneumonectomy: A recent experience and diagnostic value of dynamic magnetic resonance imaging Chest 105 931–933 Occurrence Handle1:STN:280:DyaK2c7nvVSgsA%3D%3D Occurrence Handle10.1378/chest.105.3.931

    Article  CAS  Google Scholar 

  16. MPW Dlabal BS Stutts DW Jenkins LE Harkleroad WT Stanford (1952) ArticleTitleCyanosis following right pneumonectomy: Importance of patent foramen ovale Chest 81 370–372 Occurrence Handle10.1378/chest.81.3.370

    Article  Google Scholar 

  17. J Marenco S Naimi Z Hijazi A Patel N Pandian (2000) ArticleTitleNonsurgical closure of a patent foramen ovale in a patient with carcinoid heart disease and severe hypoxia from interatrial shunting Catheter Cardiovasc Interv 51 210–213 Occurrence Handle1:STN:280:DC%2BD3M%2Fis1KgtQ%3D%3D Occurrence Handle10.1002/1522-726X(200010)51:2<210::AID-CCD17>3.0.CO;2-4

    Article  CAS  Google Scholar 

  18. DJ Waight QL Cao ZM Hijazi (2000) ArticleTitleClosure of patent foramen ovale in patients with orthodeoxia-platypnea using the Amplatzer devices Catheter Cardiovasc Interv 50 195–198 Occurrence Handle1:STN:280:DC%2BD3czgtlWmtA%3D%3D Occurrence Handle10.1002/(SICI)1522-726X(200006)50:2<195::AID-CCD11>3.0.CO;2-F

    Article  CAS  Google Scholar 

  19. MJ Landzberg LJ Sloss CE Faherty et al. (1995) ArticleTitleOrthodeoxia platypnea due to intracardiac shunting. Relief with trans-catheter double umbrella closure Cath Cardiovasc Diagn 36 247–250 Occurrence Handle1:STN:280:DyaK287islagsQ%3D%3D Occurrence Handle10.1002/ccd.1810360312

    Article  CAS  Google Scholar 

  20. A Wahl S Windecker FR Eberli C Seiler B Meier (2001) ArticleTitlePercutaneous closure of patent foramen ovale in symptomatic patients J Interv Cardiol 14 203–209 Occurrence Handle1:STN:280:DC%2BD38zht1Shuw%3D%3D Occurrence Handle10.1111/j.1540-8183.2001.tb00736.x

    Article  CAS  Google Scholar 

  21. J Hung MJ Landzberg KJ Jenkins ME King JE Lock IF Palacios P Lang (2000) ArticleTitleClosure of patent foramen ovale for paradoxical embolism: Intermediate-term risk of recurrent neurological events following transcatheter device placement J Am Coll Cardiol 35 1311–1316 Occurrence Handle1:STN:280:DC%2BD3c3itVOhtg%3D%3D Occurrence Handle10.1016/S0735-1097(00)00514-3

    Article  CAS  Google Scholar 

  22. H Sievert UU Babic G Hausdorf M Schneider HW Hopp D Pfeiffer M Pfisterer B Friedli P Urban (1998) ArticleTitleTranscatheter closure of atrial septal defect and patent foramen ovale with ASDOS device (a multi-institutional European trial) Am J Cardiol 82 1405–1413 Occurrence Handle1:STN:280:DyaK1M%2Fnt1Onug%3D%3D Occurrence Handle10.1016/S0002-9149(98)00650-X

    Article  CAS  Google Scholar 

  23. A Omeish ZM Hijazi (2001) ArticleTitleTranscatheter closure of atrial septal defects in children and adults using the Amplatzer Septal Occluder J Interv Cardiol 14 37–44 Occurrence Handle1:STN:280:DC%2BD38zht1SjtA%3D%3D Occurrence Handle10.1111/j.1540-8183.2001.tb00709.x

    Article  CAS  Google Scholar 

  24. Y Aggoun B Gallet P Acar M Pulik D Czitrom A Lagier F Laborde (2002) ArticleTitlePerforation of the aorta after percutaneous closure of an atrial septal defect with an Amplatz prosthesis, presenting with acute severe hemolysis Arch Mal Coeur 95 479–482 Occurrence Handle1:STN:280:DC%2BD38zktlShug%3D%3D Occurrence Handle12085748

    CAS  PubMed  Google Scholar 

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Author notes

  1. A. Choussat

    Present address: Formerly Hôpital cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux, France

Authors and Affiliations

  1. Hôpital G. et R. Laënnec, CHU Nantes, Nantes, France

    P. Guérin, D. Crochet & A. Choussat

  2. Centre chirurgical Marie Lannelongue, Le Plessis Robinson, France

    V. Lambert, A. Legendre, J. Petit & J. Losay

  3. Hôpital de cardiologie, CHU Lille, Lille, France

    F. Godart & C. Rey

  4. Centre cardiothoracique de Monaco, Monte Carlo, Monaco

    F. Bourlon

  5. Clinique Saint Odile, Strasbourg, France

    B. De Geeter

  6. CHU Dijon, Dijon, France

    A. Petit

  7. Hôpital de cardiologie, CHU Lyon, Lyon, France

    B. Monrozier

  8. Hôpital A. Michalon, CHU de Grenoble, Grenoble, France

    A.M. Rossignol

  9. Hôpital du Haut Lévêque, CHU de Bordeaux, Pessac, France

    M. Jimenez

  10. CHU Nantes, Hôpital Guillaume et René Laënnec, Centre hémodynamique, Boulevard Jacques Monod, BP 1005, 440930, Nantes, France

    P. Guérin

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  1. P. Guérin
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  2. V. Lambert
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Corresponding author

Correspondence to P. Guérin.

Additional information

A. Choussat was deceased.

Appendix

Appendix

Table 3. Distribution of patients by center
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Guérin, P., Lambert, V., Godart, F. et al. Transcatheter Closure of Patent Foramen Ovale in Patients with Platypnea-Orthodeoxia: Results of a Multicentric French Registry. Cardiovasc Intervent Radiol 28, 164–168 (2005). https://doi.org/10.1007/s00270-004-0035-3

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