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15 March 1993 | Volume 118 Issue 6 | Pages 473-474
Wright and colleagues [1] describe a patient with platypnea and orthodeoxia due to right-to-left shunting across an atrial septal defect, presumably because of high right atrial pressures caused by right ventricular dysfunction from eosinophilic endomyocardial disease. The protocol suggests that the patient had significant cyanosis and symptoms in the supine position. Classically, the terms platypnea and orthodeoxia are used to describe the relief of symptoms in the supine position and the development of symptoms in the sitting or standing positions. Thus, further desaturation with sitting could have occurred only with an increase in shunt. No plausible explanation is given for increased shunting due to positional changes.
We reported a case of platypnea and orthodeoxia across a patent foramen ovale in a patient with normal right-sided pressures [2]. In the supine position, our patient was fully saturated and asymptomatic but became cyanotic and dyspneic when sitting. Possible explanations for increased shunting included preferential streaming of blood from the inferior vena cava in the upright position compared with the supine position and right ventricular compliance changes with aging that allow increased shunting with positional changes. Maybe similar causes were operable in the patient described by Wright and colleagues.
1. Wright RS, Simari RD, Orszulak TA, Edwards WD, Gleich GJ, Reeder GS. Eosinophilic endomyocardial disease presenting as cyanosis, platypnea, and orthodeoxia. Ann Intern Med. 1992; 117:482-3.
2. Sorrentini MJ, Resnekov L. Patent foramen ovale associated with platypnea and orthodeoxia. Chest. 1991; 100:1157-8. About Letters
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Positional Right-to-Left Shunting
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