机译
经食管超声心动图明确显示呼吸系统正胸综合症
摘要:An 86-year-old male patient visited a cardiology outpatient clinic with dyspnea, which was prominent on standing. His blood pressure was 138/76 mm Hg and heart rate was 96/bpm. Pulse-oximeter revealed an oxygen saturation (SpO ) level of 98% in supine position; however, it decreased to 82% in the sitting position ( ). The patient was examined for the differential diagnosis of the platypnea-orthodeoxia syndrome (POS). We performed transthoracic echocardiography (TTE), and contrast transition from the right atrium (RA) to the left atrium (LA) was observed in the sitting position (Video 1). Transesophageal echocardiography (TEE) was performed to obtain a detailed visualization of interatrial septum (IAS). Patent foramen ovale (PFO) tunnel was observed in TEE and a color Doppler imaging performed revealed a transition from LA to RA in the supine position ( , ). Contrast injection from right upper extremity vein was performed, and no transition was observed in the supine position ( , Video 2). Thereafter, the patient was instructed to be in the sitting position while performing TEE, and an opening of PFO tunnel was detected ( , Video 3). Contrast transition from RA to LA was observed in the sitting position ( , Video 4). The diagnosis of PFO and POS was confirmed, and a transcatheter PFO closure was decided as the treatment strategy. The Occlutech Figulla Flex II Occluder Device (27×33 mm) was inserted to IAS. Following PFO closure, SpO was found to be normal in sitting position ( ). TTE was performed with contrast injection, and the transition from IAS did not appear in both positions (Video 5). The patient’s symptoms resolved following the procedure. POS is a rare clinical phenomenon that appears with positional symptoms and SpO changes. This syndrome is mostly associated with causes leading to an intracardiac shunt, such as PFO. Although TTE is important in cases where an intracardiac shunt is suspected, the definitive diagnosis is obtained by TEE in most patients. In these patients, contrast-enhanced TEE should be performed in the sitting position as well.