Percutaneous Intervention to Treat Platypnea–Orthodeoxia Syndrome: The Toronto Experience

Ashish H. Shah, Mark Osten, Andrew Leventhal, Yvonne Bach, Daniel Yoo, Danny Mansour, Lee Benson, William M. Wilson, Eric Horlick

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Objectives This study reviewed a series of patients treated with transcatheter closure of septal defect to treat platypnea-orthodeoxia syndrome, with specific attention to septal characteristics and device choice. Background Platypnea–orthodeoxia syndrome is an uncommon condition characterized by positional dyspnea and hypoxemia due to intracardiac right-to-left shunting through a patent foramen ovale (PFO), an atrial septal defect, or pulmonary arteriovenous malformations. Percutaneous closure of such defects is the treatment of choice. Methods In this single-center series, 52 patients were treated with percutaneous closure of an interatrial communication after presentation between January 1997 and July 2015. Septal morphology, clinical, procedural, and outcomes data were analyzed. Results All patients had a PFO; however, nearly one-quarter required a non-PFO device (11 Amplatzer Septal Occluder and 1 post-infarct muscular VSD), as opposed to a dedicated PFO device to achieve shunt occlusion. These patients were characterized by an aneurysmal septum, shorter primum septum overlap with the secundum septum, and greater septal angulation from the midline. After closure, all demonstrated acute improvements in oxygen saturation (pre-procedure: 81 ± 8%; post-procedure: 95.1 ± 0.5% on room air). Each patient was treated with a single device and no one required re-intervention. Conclusions Patients presenting with platypnea–orthodeoxia syndrome can be treated successfully with a percutaneous intervention often requiring a variety of devices. Those requiring a non-PFO–type device had a greater prevalence of an aneurysmal septum, shorter primum septal overlap with the secundum septum, and greater septal angulation with the midline.

Original languageEnglish
Pages (from-to)1928-1938
Number of pages11
JournalJACC: Cardiovascular Interventions
Issue number18
StatePublished - Sep 26 2016

Bibliographical note

Funding Information:
Dr. Horlick is supported by the Peter Munk Chair in Structural Heart Disease Intervention.

Publisher Copyright:
© 2016 American College of Cardiology Foundation


  • interatrial communication
  • percutaneous device closure
  • platypnea–orthodeoxia syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Percutaneous Intervention to Treat Platypnea–Orthodeoxia Syndrome: The Toronto Experience'. Together they form a unique fingerprint.

Cite this