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Platypnea-Orthodeoxia After TAVI for Severe Aortic Regurgitation: A Breathless Surprise
Sabrina Kopp1, Paul Stamm2, Karl-Philip Rommel1
1Department of Cardiology, University Medical Center Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Mainz, Germany.
Background:
Transcatheter aortic valve implantation (TAVI) is increasingly used in selected high-risk patients with severe native aortic regurgitation (AR). Postprocedural hemodynamic changes may cause unexpected complications.
Case Summary:
An 82-year-old woman underwent TAVI (JenaValve Trilogy 23 mm) for severe AR. She developed refractory hypoxemia due to platypnea-orthodeoxia syndrome from a patent foramen ovale (PFO) with right-to-left shunting. Percutaneous PFO closure (25/18 mm Amplatzer Talisman) restored oxygenation, and she was discharged in stable condition.
Discussion:
AR correction alters ventricular loading and may reduce left-sided filling pressures, unmasking interatrial shunting, particularly in patients with preserved systolic function and septal hypertrophy.
Take-Home Message:
Given the high prevalence of PFO, TAVI for AR may unmask right-to-left shunting, and platypnea-orthodeoxia syndrome should be considered in new-onset postprocedural hypoxemia.
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