Orthodeoxia and platypnea secondary to a patent foramen ovale despite normal right-sided cardiac pressures

Numerous cases of orthodeoxia and platypnea have been reported. Some have been found to be due to intracardiac shunts despite normal intracardiac pressures. In the case presented, a 79-year-old woman was noted to have orthodeoxia and platypnea secondary to a patent foramen ovale (PFO) despite normal intracardiac pressures. She recovered after closure of the PFO. The authors postulate that recent vertebral fractures and subsequent kyphosis, as well as a dilated thoracic aorta, altered intrathoracic relationships and may have led to a stream of venous return being directed across the PFO in the upright position, despite normal intracardiac pressures.