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(Circulation. 2001;104:741.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Platypnea-Orthodeoxia due to Aortic Elongation

Alfonso Medina, MD; Jose Suarez de Lezo, MD; Eduardo Caballero, MD; Jose Ramon Ortega, MD

From the Cardiology Department, Hospital Dr Negrín (A.M., E.C., J.R.O.), Las Palmas, University of Las Palmas, and Hospital Reina Sofia (J.S.d.L.), University of Córdoba, Córdoba, Spain.

Correspondence to Dr Alfonso Medina Fernández-Aceytuno, Servicio de Cardiología, Hospital Dr Negrín, Barranco de la Ballena s/n 35020, Las Palmas de Gran Canaria, Spain. E-mail amedina@ idecnet.com

A 67-year-old woman admitted to the hospital with syncope was found to have platypnea-orthodeoxia caused by a dilated aortic root. A transesophageal echocardiogram was taken in the supine and sitting positions (Figure). The images taken in the supine position showed the foramen ovale was closed. The images taken in the sitting position show the foramen ovale was wide open, with a massive right-to-left shunt across the defect. Oxygen saturation fell precipitously from 92% to 75% in the sitting position. The patient underwent placement of an Amplatzer patent foramen ovale occluder device and was symptom-free 8 months later.

View larger version (75K): [in this window] [in a new window]   Transesophageal echocardiogram in supine and sitting positions. Top left, Echogram taken in the supine position showing the foramen ovale is closed. Top right, Color Doppler image showing no right-to-left shunt. Bottom left, Echogram taken in the sitting position showing the foramen ovale is wide open (arrow). Bottom right, Color Doppler image showing a massive right-to-left shunt.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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