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Case Reports
. 2021 May 17;5(5):ytab176.
doi: 10.1093/ehjcr/ytab176. eCollection 2021 May.

Platypnoea-orthodeoxia syndrome after percutaneous treatment of ruptured sinus Valsalva complicated by SARS-Cov-2 pneumonia: a case report

Yaser Jenab  1 , Ali Hosseinsabet  2 , Laura Vaskelyte  3 , Kaveh Hosseini  4
Affiliations
Case Reports

Platypnoea-orthodeoxia syndrome after percutaneous treatment of ruptured sinus Valsalva complicated by SARS-Cov-2 pneumonia: a case report

Yaser Jenab et al. Eur Heart J Case Rep. .

Abstract

Background: Rupture of sinus of Valsalva (RSV) to right atrium (RA) causes significant left to right shunt, tricuspid regurgitation, and right ventricular failure. If left uncorrected it can lead to biventricular heart failure. Hence, early invasive management is advised. To date, there is no report about platypnoea-orthodeoxia syndrome (POS) after device closure of ruptured sinus of Valsalva.

Case summary: A 50-year-old woman with dyspnoea of exertion and rupture of sinus valsalva to right atrium was referred to our hospital. On admission, chest computed tomography (CT) was normal. After closure of the rupture, she developed orthostatic hypoxemia and frequent cough. A repeat chest CT was suggestive of COVID-19 infection which most probably occurred during the hospitalization. Although COVID-19 was thought to be the only culprit, her symptoms were not solely justified by COVID-19. Transthoracic echocardiography showed patent foramen ovale (PFO) with significant shunt. PFO device closure was performed under intracardiac echocardiography guidance.

Discussion: Interatrial septum deformation may happen after RSV correction and right to left shunt from PFO may become more significant. POS is an important indication for PFO closure which should be noticed by careful examination. As COVID-19 is the most frequent pathology these days, it may delay other probable diagnosis, and hence detailed history taking and physical examination is mandatory.

Keywords: COVID-19 infection; Case report; Platypnoea–orthodeoxia syndrome; Rupture of sinus of Valsalva.

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Figures

Figure 1
Figure 1
(A) Transoesophageal echocardiography, rupture of right coronary cusp to right atrium. (B) Cardiac catheterization shows rupture of right coronary cusp to right atrium (white arrow). (C) Patent ductus arteriosus occluder is visible in aorta and right atrium (white arrow).
Figure 2
Figure 2
(A) Intracardiac echocardiography shows patent foramen oval (4 mm) with right to left shunt. (B) Black arrow is patent ductus arteriosus occluder device for ruptured sinus Valsalva and white arrow is an Amplatzer device for patent foramen ovale closure.
None
See this image and copyright information in PMC

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