Mechanisms of Platypnea-Orthodeoxia: What Causes Water to Flow Uphill?
2002; Lippincott Williams & Wilkins; Volume: 105; Issue: 6 Linguagem: Inglês
10.1161/circ.105.6.e47
ISSN1524-4539
Autores Tópico(s)High Altitude and Hypoxia
ResumoHomeCirculationVol. 105, No. 6Mechanisms of Platypnea-Orthodeoxia: What Causes Water to Flow Uphill? Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBMechanisms of Platypnea-Orthodeoxia: What Causes Water to Flow Uphill? Tsung O. Cheng, MD Tsung O. ChengTsung O. Cheng Professor of Medicine, George Washington University, Washington, DC Originally published12 Feb 2002https://doi.org/10.1161/circ.105.6.e47Circulation. 2002;105:e47To the Editor:Platypnea-orthodeoxia is a relatively uncommon but striking clinical syndrome characterized by dyspnea and deoxygenation accompanying a change to a sitting or standing from a recumbent position. Since Burchell et al1 described this rare syndrome over half a century ago, no more than 50 cases have been reported in the literature.2Two conditions must coexist to cause platypnea-orthodeoxia: an anatomical component in the form of an interatrial communication and a functional component that produces a deformity in the atrial septum and results in a redirection of shunt flow with the assumption of an upright posture. The former may be an atrial septal defect, a patent foramen ovale, or a fenestrated atrial septal aneurysm. The latter may be cardiac, such as pericardial effusion or constrictive pericarditis; pulmonary, such as emphysema, arteriovenous malformation, pneumonectomy, or amiodarone toxicity; abdominal, such as cirrhosis of the liver or ileus; or vascular, such as aortic aneurysm or elongation.2Under normal conditions an interatrial communication allows blood to shunt from left to right due to a higher pressure in left atrium than right atrium and a greater compliance of the right ventricle than the left ventricle. Right-to-left interatrial shunting is usually associated with spontaneous or induced pulmonary hypertension and, therefore, in the absence of a right-to-left pressure gradient, what is the mechanism for a right-to-left shunt? Or put in another way, what causes water to flow uphill?2 A persistent Eustachian valve can cause interatrial right-to-left shunting with a normal right atrial pressure.3 Platypnea-orthodeoxia could be explained on the basis of positional modification of abnormal shunting. Standing upright could stretch the interatrial communication, be it a patent foramen ovale, an atrial septal defect, or a fenestrated atrial septal aneurysm, thus allowing more streaming of venous blood from inferior vena cava through the defect, whether or not a persistent Eustachian valve coexists.3 This redirection of flow caused by an anatomic distortion of the right atrium or the atrial septum also might occur from a loculated pericardial effusion, an aortic aneurysm, or aortic elongation.2The elegant echocardiographic demonstration by Medina et al4 is an example of the last mentioned situation. The readers are referred to my recent editorial for a more detailed discussion of the etiology, differential diagnosis, and management of platypnea-orthodeoxia.2 Suffice it to say that the definitive treatment for platypnea-orthodeoxia is closure of the interatrial communication, which can be carried out nowadays by transcatheter techniques,5 as was done in the case of Medina et al.4 References 1 Burchell HB, Helmholz HF Jr, Wood EH. Reflex orthostatic dyspnea associated with pulmonary hypertension. Am J Physiol. 1949; 159: 563–564.Google Scholar2 Cheng TO. Platypnea-orthodeoxia syndrome: etiology, differential diagnosis, and management. Cathet Cardiovasc Interv. 1999; 47: 64–66.CrossrefMedlineGoogle Scholar3 Cheng TO. Reversible orthodeoxia. Ann Intern Med. 1992; 116: 875.Google Scholar4 Medina A, Suarez de Lezo J, Caballero E, et al. Platypnea-orthodeoxia due to aortic elongation. Circulation. 2001; 104: 741.CrossrefMedlineGoogle Scholar5 Cheng TO. Transcatheter closure of patent foramen ovale: a definitive treatment for platypnea-orthodeoxia. Cathet Cardiovasc Interv. 2000; 51: 120.CrossrefMedlineGoogle ScholarcirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinsResponseMedina Alfonso, , MD, Suarez de Lezo Jose, , MD, Caballero Eduardo, , MD, and Ortega Jose Ramon, , MD12022002We appreciate very much Dr Cheng's comments regarding the definition, pathophysiology, differential diagnosis, and management of platypnea-orthodeoxia syndrome, and we completely agree with them.1From our point of view, Dr Cheng's articles2–4 help explain the underlying mechanisms of this condition and offer current recommendations for its treatment. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Krassas A, Tzifa A, Boulia S and Iliadis K (2020) Posture Dependent Hypoxia Following Lobectomy: The Achilles Tendon of the Lung Surgeon?, Journal of Investigative Surgery, 10.1080/08941939.2020.1825883, 35:1, (180-185), Online publication date: 2-Jan-2022. Puri C, Woodford M and Slack D (2022) Unexplained Hypoxemia in a Patient With Transient Ischemic Attack, Chest, 10.1016/j.chest.2021.07.050, 161:1, (e19-e22), Online publication date: 1-Jan-2022. Fuertes-Kenneally L, Quiles-Granado J, Sánchez-Quiñones J, Martínez-Martínez J, Mohammed Al-Hijji , Olsen F, Sinning C, Tardo D and Chakir M (2021) A case report of a triad causing platypnoea–orthodeoxia syndrome, European Heart Journal - Case Reports, 10.1093/ehjcr/ytab236, 5:7, Online publication date: 1-Jul-2021. Kadiyala M, Hui K, Banga S, Loomba R, Pandian N and Kutty S (2021) Persistent Right Venous Valve: Insights From Multimodality Imaging, Circulation: Cardiovascular Imaging, 14:5, Online publication date: 1-May-2021. Bradley V, Sabharwal N, MacGregor E and Bond C (2019) Postural nausea due to platypnea orthodeoxia, BMJ Supportive & Palliative Care, 10.1136/bmjspcare-2019-001918, 11:1, (1-2), Online publication date: 1-Mar-2021. Puri K, Aftab G, Madhavan A, Patel K and Puri M Platypnea-Orthodeoxia Syndrome: A Rare and Treatable Cause of Positional Dyspnea, Cureus, 10.7759/cureus.9052 Hasegawa M, Nagai T, Murakami T, Ikari Y, Sinning C, Izgi C, Brown R, Daniel G, Carazo C and Green P (2020) Platypnoea–orthodeoxia syndrome due to deformation of the patent foramen ovale caused by a dilated ascending aorta: a case report, European Heart Journal - Case Reports, 10.1093/ehjcr/ytaa045, 4:2, (1-4), Online publication date: 1-Jun-2020. Dvoretskiy L and Rezvan V (2020) Platypnea: оne more type position shortness of breath, Terapevticheskii arkhiv, 10.26442/00403660.2020.03.000436, 92:3, (92-97) Sauza-Sosa J and Millan-Iturbe O (2020) Patent Foramen Ovale Closure, Circulation: Cardiovascular Imaging, 13:3, Online publication date: 1-Mar-2020. Kuzma M, Bowers J and Farbaniec M (2020) Platypnea-Orthodeoxia Syndrome With Normal Right Heart Pressures in an Octogenarian, JACC: Case Reports, 10.1016/j.jaccas.2019.12.020, 2:2, (324-325), Online publication date: 1-Feb-2020. Larson S, Vutien P and Steinberg Z (2020) Platypnea Orthodeoxia Syndrome Secondary to Intracardiac Shunt Following Orthotopic Liver Transplantation, Journal of Investigative Medicine High Impact Case Reports, 10.1177/2324709620925575, 8, (232470962092557), Online publication date: 1-Jan-2020. Mahtta D, Mojadidi M, Tandar A, Tobis J and Meier B (2020) Hypoxemia and PFO Patent Foramen Ovale Closure for Stroke, Myocardial Infarction, Peripheral Embolism, Migraine, and Hypoxemia, 10.1016/B978-0-12-816966-7.00012-9, (143-154), . de Sousa Bispo J, Ramires I, Pestana J, Café H, Brown R, Bonaros N, Akhtar M and Green P (2019) A case report of platypnea–orthodeoxia syndrome: an interplay of pressure and blood flow, European Heart Journal - Case Reports, 10.1093/ehjcr/ytz187 Almufti T, Eversheim F, Johnson B and Akra G (2019) Platypnoea–orthodeoxia after left total knee replacement, BMJ Case Reports, 10.1136/bcr-2019-230771, 12:10, (e230771), Online publication date: 1-Oct-2019. Solomon C, Berg D, Kirshenbaum J, Gay E, Miller A and Loscalzo J (2019) A Dangerous Detour, New England Journal of Medicine, 10.1056/NEJMcps1803916, 380:14, (1360-1365), Online publication date: 4-Apr-2019. Mojadidi M, Ruiz J, Chertoff J, Zaman M, Elgendy I, Mahmoud A, Al-Ani M, Elgendy A, Patel N, Shantha G, Tobis J and Meier B (2019) Patent Foramen Ovale and Hypoxemia, Cardiology in Review, 10.1097/CRD.0000000000000205, 27:1, (34-40), Online publication date: 1-Jan-2019. Madden K, MacKintosh A and Mike N (2018) Patent foramen ovale causing breathlessness and platypnoea-orthodeoxia syndrome in an older patient, Age and Ageing, 10.1093/ageing/afy150, 48:1, (157-159), Online publication date: 1-Jan-2019. Kenny C, Murphy C, Clough L and Ashley D (2019) Positional cyanosis reveals platypnea-orthodeoxia-syndrome, Respiratory Medicine Case Reports, 10.1016/j.rmcr.2019.100941, 28, (100941), . Soga Y, Kira H, Ikeda T, Su T, Doi K, Wakamiya M, Nakano A and Himura Y (2018) Platypnea-orthodeoxia syndrome associated with aortic insufficiency and aortic elongation, Journal of Cardiac Surgery, 10.1111/jocs.13712, 33:6, (313-315), Online publication date: 1-Jun-2018. van der Veer T, in 't Veen J, den Dekker W and Miedema J (2017) A 79-Year-Old Woman With Dyspnea and Hypoxemia That Worsened in an Upright Position, Chest, 10.1016/j.chest.2017.07.004, 152:6, (e139-e142), Online publication date: 1-Dec-2017. Zardi E, Spoto S, Locorriere L, Cacioli G, Mazzaroppi S, Zobel B, Di Sciascio G and Costantino S (2017) Platypnoea-orthodeoxia syndrome in the elderly: A difficult-to-make diagnosis of intracardiac right-to-left shunt, Scottish Medical Journal, 10.1177/0036933017727430, 62:3, (122-125), Online publication date: 1-Aug-2017. Agrawal A, Palkar A and Talwar A (2017) The multiple dimensions of Platypnea-Orthodeoxia syndrome: A review, Respiratory Medicine, 10.1016/j.rmed.2017.05.016, 129, (31-38), Online publication date: 1-Aug-2017. Layoun M, Aboulhosn J and Tobis J (2017) Potential Role of Patent Foramen Ovale in Exacerbating Hypoxemia in Chronic Pulmonary Disease, Texas Heart Institute Journal, 10.14503/THIJ-16-6027, 44:3, (189-197), Online publication date: 1-Jun-2017. De Vecchis R, Baldi C, Ariano C, Giasi A and Cioppa C (2016) Platypnea–orthodeoxia syndromePlatypnoe-Orthodeoxie-Syndrom, Herz, 10.1007/s00059-016-4479-4, 42:4, (384-389), Online publication date: 1-Jun-2017. Rudy C, Ballard C, Broberg C and Hunter A (2016) Platypnea-Orthodeoxia Syndrome: A Case of Chronic Paroxysmal Hypoxemia, Journal of General Internal Medicine, 10.1007/s11606-016-3901-1, 32:1, (127-130), Online publication date: 1-Jan-2017. De Vecchis R, Baldi C and Ariano C (2016) Platypnea–Orthodeoxia Syndrome: Multiple Pathophysiological Interpretations of a Clinical Picture Primarily Consisting of Orthostatic Dyspnea, Journal of Clinical Medicine, 10.3390/jcm5100085, 5:10, (85) Di Meglio L, Bottin L and de Broucker T (2016) Syndrome de platypnée-orthodéoxie associé à une embolie paradoxale liée à la persistance d'un foramen ovale perméable, Pratique Neurologique - FMC, 10.1016/j.praneu.2016.07.005, 7:3, (213-218), Online publication date: 1-Sep-2016. Sabater Abad C, Juan Samper G, Payá Serrano R, Pérez Boscá J, Ramón Capilla M and Fernandez Fabrellas E (2016) Síndrome platipnea-ortodeoxia cardiaco: una causa «misteriosa» de hipoxemia, Archivos de Bronconeumología, 10.1016/j.arbres.2016.02.003, 52:9, (494-495), Online publication date: 1-Sep-2016. Sabater Abad C, Juan Samper G, Payá Serrano R, Pérez Boscá J, Ramón Capilla M and Fernandez Fabrellas E (2016) Cardiac Platypnea-orthodeoxia Syndrome: A "Mysterious" Cause of Hypoxemia, Archivos de Bronconeumología (English Edition), 10.1016/j.arbr.2016.07.007, 52:9, (494-495), Online publication date: 1-Sep-2016. Ducey S and Cooper J (2016) Hypovolemia Resulting in Platypnea-Orthodeoxia Syndrome, The Journal of Emergency Medicine, 10.1016/j.jemermed.2015.06.020, 50:3, (482-484), Online publication date: 1-Mar-2016. Werlang M, Palmer W, Boyd E, Cangemi D, Harnois D, Taner C and Stancampiano F (2015) Patent foramen ovale in liver transplant recipients does not negatively impact short-term outcomes, Clinical Transplantation, 10.1111/ctr.12643, 30:1, (26-32), Online publication date: 1-Jan-2016. Xu B, Mottram P and Peverill R (2016) Platypnoea-orthodeoxia syndrome: to assess breathlessness occurring in the upright position, transthoracic echocardiography should be performed in the upright position, International Journal of Cardiology, 10.1016/j.ijcard.2015.09.097, 202, (636-638), Online publication date: 1-Jan-2016. Nassif M, Lu H, Konings T, Bouma B, Vonk Noordegraaf A, Straver B, Blom N, Clur S, Backx A, Groenink M, Boekholdt S, Koolbergen D, Hazekamp M, Mulder B and de Winter R (2015) Platypnoea-orthodeoxia syndrome, an underdiagnosed cause of hypoxaemia: four cases and the possible underlying mechanisms, Netherlands Heart Journal, 10.1007/s12471-015-0714-5, 23:11, (539-545), Online publication date: 1-Nov-2015. Henkin S, Negrotto S, Pollak P, Cullen M, O'Cochlain D and Wright R (2015) Platypnea-Orthodeoxia Syndrome: Diagnostic Challenge and the Importance of Heightened Clinical Suspicion, Texas Heart Institute Journal, 10.14503/THIJ-14-4596, 42:5, (498-501), Online publication date: 1-Oct-2015. Loncar G, Payot L and Dubois M (2015) TIA Caused by Contrast Echocardiography in Patient with Platypnea-Orthodeoxia, Echocardiography, 10.1111/echo.12970, 32:10, (1585-1587), Online publication date: 1-Oct-2015. Mojadidi M, Gevorgyan R, Noureddin N and Tobis J (2015) The effect of patent foramen ovale closure in patients with platypnea-orthodeoxia syndrome, Catheterization and Cardiovascular Interventions, 10.1002/ccd.25953, 86:4, (701-707), Online publication date: 1-Oct-2015. Mojadidi M, Winoker J, Roberts S, Msaouel P, Zaman M, Gevorgyan R and Tobis J (2014) Accuracy of Conventional Transthoracic Echocardiography for the Diagnosis of Intracardiac Right-to-Left Shunt: A Meta-Analysis of Prospective Studies, Echocardiography, 10.1111/echo.12583, 31:9, (1036-1048), Online publication date: 1-Oct-2014. Deroux A, Chidlovskii E, Bosc C, Pison C and Couturier P (2014) Syndrome de platypnée-orthodéoxie : une cause rare d'hypoxémie sévère, Revue de Pneumologie Clinique, 10.1016/j.pneumo.2014.01.002, 70:5, (307-310), Online publication date: 1-Oct-2014. Pai V, Vallurupalli S, Kasula S, Hakeem A and Bhatti S (2014) A Change of Heart: Reopening of a Foramen Ovale, Canadian Journal of Cardiology, 10.1016/j.cjca.2014.03.027, 30:10, (1250.e17-1250.e18), Online publication date: 1-Oct-2014. Knapper J, Schultz J, Das G and Sperling L (2014) Cardiac Platypnea-Orthodeoxia Syndrome: An Often Unrecognized Malady, Clinical Cardiology, 10.1002/clc.22301, 37:10, (645-649), Online publication date: 1-Oct-2014. Rodrigues P, Monteiro M, Palma P, Sousa-Pereira L, Cabral S, Oliveira F, Dias V and Torres S (2014) Body position and oxygenation: An intriguing relationship, Revista Portuguesa de Cardiologia (English Edition), 10.1016/j.repce.2014.01.012, 33:6, (385.e1-385.e5), Online publication date: 1-Jun-2014. Rodrigues P, Monteiro M, Palma P, Sousa-Pereira L, Cabral S, Oliveira F, Dias V and Torres S (2014) Body position and oxygenation: An intriguing relationship, Revista Portuguesa de Cardiologia, 10.1016/j.repc.2014.01.016, 33:6, (385.e1-385.e5), Online publication date: 1-Jun-2014. Holcman K, Cameron S, Laskurain E, Massey H, Trawick D and Mieszczanska H (2014) Breathtaking: Platypnea-orthodeoxia Syndrome, The American Journal of Medicine, 10.1016/j.amjmed.2014.02.029, 127:6, (491-493), Online publication date: 1-Jun-2014. Low Z, Darvall J and Radford S (2014) Platypnoea-Orthodeoxia Syndrome Post Laparoscopic Surgery in a Patient with a Patent Foramen Ovale, Anaesthesia and Intensive Care, 10.1177/0310057X1404200317, 42:3, (385-388), Online publication date: 1-May-2014. Haga T and Muramoto E (2014) Platypnea orthodeoxia syndrome associated with patent foramen ovale incidentally diagnosed in a patient with ventriculitis/bacterial meningitis, Nosotchu, 10.3995/jstroke.36.71, 36:2, (71-75), . Fukuoka R, Kawasaki T, Koga H, Umeji K, Orita Y, Shintani Y, Kajiwara M, Higuchi T, Ishida K and Fujimura T (2014) Platypnea-orthodeoxia Syndrome Associated with a Thoracic Vertebral Fracture Following a Car Accident, Internal Medicine, 10.2169/internalmedicine.53.0797, 53:1, (35-38), . Ning M, Lo E, Ning P, Xu S, McMullin D, Demirjian Z, Inglessis I, Dec G, Palacios I and Buonanno F (2013) The brain's heart — Therapeutic opportunities for patent foramen ovale (PFO) and neurovascular disease, Pharmacology & Therapeutics, 10.1016/j.pharmthera.2013.03.007, 139:2, (111-123), Online publication date: 1-Aug-2013. Cheng T (2013) Emeritus, old age, William Osler and William Dock, International Journal of Cardiology, 10.1016/j.ijcard.2012.09.012, 164:2, (129-132), Online publication date: 1-Apr-2013. Yastrebov K, Sader M, Youssef G and Nojoumian H (2015) Dynamic echocardiography in evaluation of platypnoea-orthodeoxia, Australasian Journal of Ultrasound in Medicine, 10.1002/j.2205-0140.2012.tb00230.x, 15:2, (71-75), Online publication date: 1-May-2012. Devendra G, Rane A and Krasuski R (2012) Provoked Exercise Desaturation in Patent Foramen Ovale and Impact of Percutaneous Closure, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2012.01.011, 5:4, (416-419), Online publication date: 1-Apr-2012. Pedra C and Pedra S (2012) Atrial Level Shunts Including Partial Anomalous Pulmonary Venous Connection and Scimitar Syndrome Pediatric Cardiovascular Medicine, 10.1002/9781444398786.ch21, (289-307), Online publication date: 10-Feb-2012. Bakalli A, Koçinaj D, Georgievska-Ismail L, Bekteshi T, Pllana E and Sejdiu B (2011) Right bundle branch block as a marker for interatrial septal abnormalities, Cardiology in the Young, 10.1017/S1047951111000795, 22:1, (18-25), Online publication date: 1-Feb-2012. Odell J, Keller C, Erasmus D and Stritt M (2012) Traumatic Bronchial Rupture and Platypnea-Orthodeoxia, The Annals of Thoracic Surgery, 10.1016/j.athoracsur.2011.07.072, 93:2, (662-664), Online publication date: 1-Feb-2012. Takase B, Tanaka Y, Hattori H and Ishihara M (2012) Importance of Platypnea Orthodeoxia in the Differential Diagnosis of Dyspnea, Internal Medicine, 10.2169/internalmedicine.51.7720, 51:13, (1651-1652), . Daly D, Fonbah W, Misra V, Vengala S, Nagaraj H, Rogers W and Lloyd S (2011) High risk closure of a large secundum ASD causing platypnea-orthodeoxia, International Journal of Cardiology, 10.1016/j.ijcard.2010.12.003, 152:3, (e52-e54), Online publication date: 1-Nov-2011. Garin N, Carballo S, Petitpierre N, Bigin Younossian A, Gerstel E and Benghia S (2011) Le grand bleu, La Revue de Médecine Interne, 10.1016/j.revmed.2011.05.005, 32:8, (519-522), Online publication date: 1-Aug-2011. Gallerini S, Calchetti B, Cianchi C, Di Troia A, Madonna R, Cresti A and Mancuso M (2011) Can patent foramen ovale affect rehabilitation? The uncommon association of platypnea-orthodeoxia syndrome and stroke, Neurological Sciences, 10.1007/s10072-011-0572-x, 32:3, (513-514), Online publication date: 1-Jun-2011. Vallejo N, Ferrer E, Fernández-Nofrerías E and Mauri J (2010) Postpneumonectomy Dyspnea: Improvement After Transcatheter Closure, Revista Española de Cardiología (English Edition), 10.1016/S1885-5857(10)70105-5, 63:4, (498-499), Online publication date: 1-Apr-2010. Pierce C (2010) Platypnea-orthodeoxia syndrome in an elderly woman with a patent foramen ovale, Canadian Journal of Cardiology, 10.1016/S0828-282X(10)70372-X, 26:4, (213-214), Online publication date: 1-Apr-2010. Vallejo N, Ferrer E, Fernández-Nofrerías E and Mauri J (2010) Disnea tras neumonectomía: mejoría tras cierre percutáneo, Revista Española de Cardiología, 10.1016/S0300-8932(10)70077-4, 63:4, (498-499), Online publication date: 1-Apr-2010. Katsoulis K, Minasidis I, Vainas A, Bikas C, Kontakiotis T and Vakianis P (2009) Platypnea and orthodeoxia associated with Pneumocystis jiroveci and Cytomegalovirus pneumonia: a case report, Journal of Medical Case Reports, 10.1186/1752-1947-3-9319, 3:1, Online publication date: 1-Dec-2009. Sakamoto J, Izumi C, Takahashi S, Hashiwada S, Yamao K, Hanazawa K, Yoshitani K, Miyake M, Motooka M, Kaitani K, Izumi T, Gen H and Nakagawa Y (2009) The usefulness of contrast echocardiography for detecting right-to-left cardiac shunts during the diagnosis of hypoxemia: 2 case reports, Journal of Cardiology, 10.1016/j.jjcc.2009.03.006, 54:3, (494-498), Online publication date: 1-Dec-2009. Martinis G, Zamora E, Hoyos N, Domínguez L, Segrelles G and Girón R (2009) Paciente con síndrome de platipnea ortodesoxia, Revista de Patología Respiratoria, 10.1016/S1576-9895(09)70048-7, 12:4, (171-174), Online publication date: 1-Oct-2009. Kusunose K, Yamada H, Todoroki T, Nishio S, Niki T, Yamaguchi K, Koshiba K, Yagi S, Iwase T, Soeki T, Wakatsuki T, Akaike M, Kitagawa T and Sata M (2009) Platypnea-Orthodeoxia Syndrome Associated with Patent Foramen Ovale and Aortic Ectasia, Echocardiography, 10.1111/j.1540-8175.2008.00780.x, 26:1, (114-117), Online publication date: 1-Jan-2009. Alazemi S, Tzur A, Morla D, Londono J and Chediak A (2008) RIGHT TO LEFT SHUNT THROUGH PATENT FORAMEN OVALE DUE TO AN ISOLATED POSITIONAL INCREASE IN RIGHT ATRIAL PRESSURE, Chest, 10.1378/chest.134.4_MeetingAbstracts.c15002, 134:4, (15C), Online publication date: 1-Oct-2008. Shakur R, Ryding A, Timperley J, Becher H and Leeson P (2008) Late emergence of platypnea orthodeoxia: Chiari network and atrial septal hypertrophy demonstrated with transoesophageal echocardiography, European Heart Journal - Cardiovascular Imaging, 10.1093/ejechocard/jen015, 9:5, (694-696), Online publication date: 1-Sep-2008., Online publication date: 1-Sep-2008. Alonso Martínez J (2008) Respuesta de los autores, Medicina Clínica, 10.1016/S0025-7753(08)72253-X, 131:7, (278), Online publication date: 1-Sep-2008. Cheng T (2008) Patent foramen ovale in high-altitude pulmonary edema: A vicious cycle, International Journal of Cardiology, 10.1016/j.ijcard.2007.01.122, 126:3, (433-434), Online publication date: 1-Jun-2008. Tumgor G, Arikan C, Yuksekkaya H, Cakir M, Levent E, Yagci R, Kilic M and Aydogdu S (2008) Childhood cirrhosis, hepatopulmonary syndrome and liver transplantation, Pediatric Transplantation, 10.1111/j.1399-3046.2007.00807.x, 12:3, (353-357), Online publication date: 1-May-2008. Schoebel F, Jax T, Peters A, Kreis I, Siebler M and Heintzen M (2008) Patent foramen ovale: What causes water to flow uphill? – More views, International Journal of Cardiology, 10.1016/j.ijcard.2006.11.193, 124:3, (e45-e46), Online publication date: 1-Mar-2008. Cheng T (2007) Eustachian valve, patent foramen ovale and paradoxical embolism, International Journal of Cardiology, 10.1016/j.ijcard.2006.05.029, 117:1, (138-139), Online publication date: 1-Apr-2007. Cheng T (2006) Patent Foramen Ovale and Migraine, The American Journal of Cardiology, 10.1016/j.amjcard.2006.04.005, 98:7, (990-991), Online publication date: 1-Oct-2006. Suzuki H, Ohuchi H, Hiraumi Y, Yasuda K and Echigo S (2006) Effects of postural change on oxygen saturation and respiration in patients after the Fontan operation: Platypnea and orthodeoxia, International Journal of Cardiology, 10.1016/j.ijcard.2005.01.044, 106:2, (211-217), Online publication date: 1-Jan-2006. Hara H, Virmani R, Ladich E, Mackey-Bojack S, Titus J, Reisman M, Gray W, Nakamura M, Mooney M, Poulose A and Schwartz R (2005) Patent Foramen Ovale: Current Pathology, Pathophysiology, and Clinical Status, Journal of the American College of Cardiology, 10.1016/j.jacc.2005.08.038, 46:9, (1768-1776), Online publication date: 1-Nov-2005. Hsu P, Leu H, Lu T, Yu W and Hsu T (2004) Platypnea-orthodeoxia syndrome occurring after a blunt chest trauma with acute tricuspid regurgitation, The American Journal of Medicine, 10.1016/j.amjmed.2004.09.010, 117:11, (890-891), Online publication date: 1-Dec-2004. February 12, 2002Vol 105, Issue 6 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.105.6.e47PMID: 11839642 Originally publishedFebruary 12, 2002 PDF download Advertisement
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