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Case Reports
. 2017 Nov 29;30(11):827-830.
doi: 10.20344/amp.8700. Epub 2017 Nov 29.

Platypnea-Orthodeoxia Syndrome After Complicated Cholecystectomy: An Unsuspected Diagnosis

Catarina Queirós  1 , Elsa Francisco  2 , João Almeida  3
Affiliations
Free article
Case Reports

Platypnea-Orthodeoxia Syndrome After Complicated Cholecystectomy: An Unsuspected Diagnosis

Catarina Queirós et al. Acta Med Port. .
Free article

Abstract
in English, Portuguese

A 65-year-old woman with no significant prior medical history presented, in the postoperative course of a complicated cholecystectomy, several episodes of arterial desaturation. Pulmonary embolism was repeatedly suspected, but there was no evidence of pulmonary thrombus on the chest computed tomography angiographies obtained. As these episodes were mainly induced by postural changes, a platypnea-orthodeoxia syndrome was suspected. A transthoracic echocardiogram was performed and revealed a patent foramen ovale. A transesophageal echocardiography confirmed the presence of a significant right-to-left shunt exacerbated by the Valsalva manouver. The defect was repaired using a percutaneous transcatheter technique with complete resolution of the condition.

Doente do sexo feminino, 65 anos de idade, sem antecedentes pessoais relevantes, apresentou no pós-operatório de uma colecistectomia complicada diversos episódios de dessaturação arterial. Suspeitou-se repetidamente de tromboembolismo pulmonar, no entanto as diversas angio-tomografias computorizadas obtidas nunca revelaram a presença de trombos no leito vascular pulmonar. Atendendo a que os episódios de dessaturação eram maioritariamente despoletados por alterações posturais, foi levantada a hipótese de se tratar de uma síndrome de platipneia-ortodeoxia. Foi realizado ecocardiograma transtorácico, que revelou um foramen oval patente; o ecocardiograma transesofágico confirmou a presença de um shunt direito-esquerdo significativo, exacerbado pela manobra de Valsalva. O defeito foi reparado através de uma técnica transcatéter, com resolução completa do quadro clínico.

Keywords: Cholecystectomy; Dyspnea; Foramen Ovale, Patent; Hypoxia; Syndrome.

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