Objectives: Platypnea-orthodeoxia syndrome is a rare complication of right pneumonectomy which is attributed to an inter-atrial right-to-left shunt through a ...
Interactive CardioVascular and Thoracic Surgery
Abstracts 23rd European Conference on General Thoracic Surgery 31 May–3 June 2015, Lisbon, Portugal P-237 EARLY-ONSET OF PLATYPNEA-ORTHODEOXIA SYNDROME AFTER RIGHT INTRAPERICARDIAL TRACHEOPLASTIC PNEUMONECTOMY C. Foroulis1, Athanassios Kleontas1 , G. Tagarakis1, V. Grosomanidis2, S. Hadjimiltiadis3, P. Tossios1, K. Anastasiadis1 1 Department of Cardiothoracic Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Department of Anaesthesiology and Intensive Care, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece Objectives: Platypnea-orthodeoxia syndrome is a rare complication of right pneumonectomy which is attributed to an inter-atrial right-to-left shunt through a patent foramen ovale (PFO) due to mediastinal shifting that causes anatomical changes in the caval orifices/axis and in the interatrial septum. A rare case of platypnea-orthodeoxia syndrome that became clinically evident on the 1st postoperative day after right pneumonectomy is reported. Case description: A 51-year old man underwent right intrapericardial tracheoplastic pneumonectomy for a squamous cell carcinoma of the right main bronchus invading the right tracheobronchial angle. Severe symptomatic
oxygen desaturation (SpO2: 75-83%) occurred on the 1st postoperative day, after the patient’s first attempt to stand up, and oxygen saturation returned gradually to normal (SpO2: 95-99%) in the supine position. The suspicion of a right-to-left shunt through a PFO was confirmed by transoesophageal echocardiography (TOE). The patient underwent successful treatment of the syndrome via the insertion of a 30-mm PFO occluder device in the cardiac catheterization laboratory. Pulmonary hypertension was not detected by either TOE or during right heart catheterization. Immediately after PFO closure and complete interruption of the right-to-left shunting, oxygen saturation returned to normal levels in any body position. The patient had an otherwise uncomplicated postoperative course. Conclusions: Early occurrence of platypnea-orthodoexia syndrome is a very rare complication of right pneumonectomy which can be attributed to the existence of PFO and to the extensive dissection of mediastinal structures that is mandatory to perform a right tracheoplastic pneumonectomy. Clinical suspicion of the syndrome, detection of interatrial shunting through TEE and closure of the PFO via percutaneous insertion of a PFO occluder device resolves the syndrome and normalizes the postoperative course. Disclosure: No significant relationships.
