Turning the Tide: Unraveling Aortic Dynamics and Patent Foramen Ovale in Platypnea-Orthodeoxia Syndrome

Platypnea-orthodeoxia syndrome (POS) is a rare disorder characterized by positional dyspnea and hypoxemia due to right-to-left shunting, often through a patent foramen ovale (PFO). It requires both an anatomical substrate and a functional trigger.

A man in his 70s presented with acute cerebellar stroke, breathlessness, and profound hypoxia worsened by the upright position. He tested positive for COVID-19, and computed tomography demonstrated a small pulmonary embolism, aorta dilation, and steep aortic angulation. Transthoracic echocardiography with a bubble study confirmed the presence of a PFO with right-to-left shunting during the Valsalva maneuver. Percutaneous PFO closure resulted in clinical improvement and resolution of hypoxemia.

This case highlights the interplay of PFO, aortic dilatation, and aortic angulation as key contributors to POS. Multimodal imaging is crucial for diagnosis and management.

POS should be considered in positional hypoxia cases, and imaging is essential for diagnosis and treatment planning.