Patent foramen ovale causing position-dependent shunting in a patient, when laying down her corset

A 75-yr-old female presented with platypnoea and orthodeoxia, shortly after laying down an old and pinching corset. The injection of activated Haemacc el in the right cubital vene during transoesophageal echocardiography, in t he upright position, revealed a direct blood flow from the superior caval v ein at a patent foremen ovale, consequently opening it and causing a large right-to-left shunt which was calculated at 28.5%. In the supine position t here was only a minimal opening of the patent foremen ovale with a calculat ed right-to-left shunt of 9.5%. The patent foremen ovale was successfully c losed percutaneously with a CardioSEAL(TM).