Platypnea-orthodeoxia: Management by transcatheter buttoned device implantation

P. Syamasundar Rao, Igor F. Palacios, Richard G. Bach, Saad R. Bitar, Eleftherios B. Sideris

Research output: Contribution to journalArticle

41 Scopus citations


Dyspnea and arterial desaturation on upright position in elderly subjects is 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 available treatment option. Buttoned device has been used for occlusion of ostium secundum ASD, PFO associated with presumed paradoxical embolism and cerebrovascular accidents and ASD/PFO in association with other congenital heart defects causing right-to-left shunt. The objective of this article is to describe the use of buttoned device in effectively occluding ASD/PFO to relieve 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 closure of their ASD/PFO. Echocardiographic and balloon-stretched atrial defect sizes were 8 ± 3 mm and 12 ± 3 mm, respectively. The ASD/PFO were occluded 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 placed on the right atrial side. The oxygen saturation increased (P < 0.001) from 76 ± 7% (range 69-86%) to 95 ± 2% (range 92-98%). No complications were 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 feasible, safe, and effective and is an excellent alternative to surgery.

Original languageEnglish
Pages (from-to)77-82
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Issue number1
StatePublished - Sep 27 2001
Externally publishedYes


  • Atrial septal defect
  • Buttoned device
  • Interatrial right-to-left shunt
  • Nonsurgical closure
  • Patent foramen ovale
  • Platypnea-orthodeoxia
  • Transcatheter occlusion

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