• Takahiro Ohara, Satoshi Nakatani, Shuji Hashimoto, Yasuhisa Akaiwa, Satoshi Yazaki, Koji Kimura, Izuru Nakasone, Yoshikazu Masuda, Hideaki Kanzaki, and Masafumi Kitakaze.
• Cardiovascular Division, National Cardiovascular Center, Osaka, Japan. tkohara@hsp.ncvc.go.jp <tkohara@hsp.ncvc.go.jp>
• J Am Soc Echocardiogr. 2007 Apr 1;20(4):439.e5-10.

AbstractWe describe a case of a rare clinical disorder, platypnea-orthodeoxia syndrome. A 57-year-old man was admitted with progressive dyspnea. While breathing room air, arterial oxygen saturation decreased from 92% in a recumbent position to 83% in an upright position. Transthoracic echocardiography revealed normal left and right ventricular function, but intravenous infusion of air-blood-saline resulted in the appearance of microbubbles in the left side of the heart, indicating the presence of right-to-left shunt. Transesophageal echocardiography demonstrated a small amount of right-to-left shunting through a patent foramen ovale. Further, the left lower pulmonary vein was dilated, and contrast echocardiography revealed drainage of microbubbles mainly from the left lower pulmonary vein. A pulmonary angiogram revealed the presence of a pulmonary arteriovenous fistula. The patient underwent embolization of the arteriovenous fistula with subsequent resolution of dyspnea and hypoxemia. Platypnea-orthodeoxia syndrome is rare, and patients with this syndrome require an extensive workup to determine its cause.

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