Platypnea-Orthodeoxia Syndrome Manifesting as an Early Complication after Lower Bilobectomy
Carmelina C. Zirafa,
Alessandra Lenzini,
Paolo Spontoni,
Claudia Cariello,
Luca Doroni,
Adrea Pieroni,
Anna S. Petronio,
Franca Melfi
Affiliations
Carmelina C. Zirafa
Minimally Invasive and Robotic Thoracic Surgery Division, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy
Alessandra Lenzini
Thoracic Surgery Unit, Department of Surgical, Medical, Molecular, Pathology and Critical Care, University Hospital of Pisa, 56124 Pisa, Italy
Paolo Spontoni
Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
Claudia Cariello
Cardiothoracic and Vascular Anaesthesia and Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, 56124 Pisa, Italy
Luca Doroni
Cardiothoracic and Vascular Anaesthesia and Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, 56124 Pisa, Italy
Adrea Pieroni
Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
Anna S. Petronio
Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
Franca Melfi
Minimally Invasive and Robotic Thoracic Surgery Division, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy
Platypnea-orthodeoxia syndrome (POS) is an uncommon clinical condition characterized by orthostatic dyspnea and hypoxemia. The case of a female patient who manifested postoperative episodes of sudden oxygen desaturation, dyspnea, and systemic arterial hypotension following lower bilobectomy for lung adenocarcinoma was reported. After meticulous clinical investigations, the patient proved to be affected by a rare form of postural dyspnea: platypnea-orthodeoxia syndrome, a clinical disorder described in the middle of the last century. The pathophysiology was found in an intracardiac mechanism of right-to-left blood shunt, combined with lung and chest wall modification. Atrial septal defect, such as patent foramen ovale (PFO), is a common cause of platypnea-orthodeoxia syndrome; the rescue closure of PFO usually allows for an immediate and consistent improvement of the symptoms.
