Platypnea-orthodeoxia: Management by transcatheter buttoned device implantation

Dyspnea and arterial desaturation on upright position in elderly subjects i s described as platypnea-orthodeoxia syndrome (POS) and in some patients it is due to right-to-left shunt across the atrial septal defect (ASD)/patent foramen ovale (PFO). Surgical closure of ASD/PFO has been the only availab le treatment option. Buttoned device has been used for occlusion of ostium secundum ASD, PFO associated with presumed paradoxical embolism and cerebro vascular accidents and ASD/PFO in association with other congenital heart d efects causing right-to-left shunt. The objective of this article is to des cribe the use of buttoned device in effectively occluding ASD/PFO to reliev e hypoxemia of POS. During a 4-year period ending January 2000, 10 patients , ages 71 +/- 9 (range 60-83) years with POS underwent buttoned device clos ure of their ASD/PFO. Echocardiographic and balloon-stretched atrial defect sizes were 8 +/- 3 mm and 12 +/- 3 mm, respectively. The ASD/PFO were occl uded with devices ranging in size from 25 to 40 mm delivered via 9 French, long, blue Cook sheaths; eight had an additional 25- or 35-mm occluder plac ed on the right atrial side. The oxygen saturation increased (P < 0.001) fr om 76 +/- 7% (range 69-86%) to 95 +/- 2% (range 92-98%). No complications w ere encountered. Relief of symptoms was seen in all patients. Follow-up of 1-36 months (median 12 months) revealed persistent improvement of symptoms. Buttoned device occlusion of ASD/PFO to relieve hypoxemia of POS is feasib le, safe, and effective and is an excellent alternative to surgery. (C) 200 1 Wiley-Liss, Inc.