{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T07:07:39Z","timestamp":1773644859330,"version":"3.50.1"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Platypnea-orthodeoxia syndrome (POS) is a rare but treatable cause of positional hypoxaemia, typically associated with intracardiac shunting. We present the first documented case of POS secondary to patent foramen ovale (PFO) in a patient with right-dominant arrhythmogenic cardiomyopathy (ACM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 48-year-old male with right-dominant ACM developed progressive dyspnoea and upright hypoxaemia. Workup examinations revealed atrial flutter and PFO with right-to-left shunting. PFO occlusion resolved hypoxaemia, with sustained improvement at 3-year follow-up despite progressive RV dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case represents a rare form of POS attributable to the coexistence of PFO and right-dominant ACM. The pathophysiological mechanism underlying POS in this case might be parallel to that observed in right ventricular myocardial infarction or ischaemia in which elevated right-sided intracardiac pressures due to impaired RV output secondary to right heart dysfunction equals or surpasses left heart pressure which created a pressure gradient favourable for right-to-left shunting (RLS) through the PFO in upright position. Based on comprehensive clinical evaluation, PFO closure was ultimately performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights right-dominant ACM as a novel predisposing factor for POS via PFO shunting. The pathophysiological mechanism underlying POS in this case might be parallel to that observed in right ventricular myocardial infarction or ischaemia. PFO closure may be curative for right-dominant ACM-related hypoxaemia and POS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag140","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T12:53:37Z","timestamp":1772283217000},"source":"Crossref","is-referenced-by-count":0,"title":["Right-dominant arrhythmogenic cardiomyopathy complicated by platypnea-orthodeoxia syndrome: a novel mechanism of patent foramen Ovale-mediated hypoxaemia: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8830-8234","authenticated-orcid":false,"given":"Xiaoyu","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University , No. 96, Dongchuan Road, Yuexiu District, Guangzhou, Guangdong 510080 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1803-2575","authenticated-orcid":false,"given":"Shuang","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University , No. 96, Dongchuan Road, Yuexiu District, Guangzhou, Guangdong 510080 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"2026031602312501900_ytag140-B1","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1016\/j.jcin.2016.07.003","article-title":"Percutaneous intervention to treat platypnea-orthodeoxia syndrome: the Toronto experience","volume":"9","author":"Shah","year":"2016","journal-title":"JACC Cardiovasc Interv"},{"key":"2026031602312501900_ytag140-B2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.rmed.2017.05.016","article-title":"The multiple dimensions of platypnea-orthodeoxia syndrome: a review","volume":"129","author":"Agrawal","year":"2017","journal-title":"Respir Med"},{"key":"2026031602312501900_ytag140-B3","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ijcard.2020.06.005","article-title":"Diagnosis of arrhythmogenic cardiomyopathy: the Padua criteria","volume":"319","author":"Corrado","year":"2020","journal-title":"Int J Cardiol"},{"key":"2026031602312501900_ytag140-B4","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/eurheartj\/ehac180","article-title":"A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy","volume":"43","author":"Cadrin-Tourigny","year":"2022","journal-title":"Eur Heart J"},{"key":"2026031602312501900_ytag140-B5","article-title":"Treatment of arrhythmogenic right ventricular cardiomyopathy\/dysplasia: an international task force consensus statement","volume":"36","author":"Corrado","year":"2015","journal-title":"Eur Heart J"},{"key":"2026031602312501900_ytag140-B6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1159\/000339872","article-title":"Platypnea-orthodeoxia syndrome in review: defining a new disease?","volume":"123","author":"Rodrigues","year":"2012","journal-title":"Cardiology"},{"key":"2026031602312501900_ytag140-B7","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1161\/CIRCULATIONAHA.121.054424","article-title":"Platypnea-orthodeoxia syndrome: a case of persistent hypoxemia in an elderly patient","volume":"144","author":"Ribeiro","year":"2021","journal-title":"Circulation"},{"key":"2026031602312501900_ytag140-B8","doi-asserted-by":"crossref","first-page":"E55","DOI":"10.1002\/clc.20461","article-title":"Anatomical factors triggering platypnea-orthodeoxia in adults","volume":"32","author":"Sanikommu","year":"2009","journal-title":"Clin Cardiol"},{"key":"2026031602312501900_ytag140-B9","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/S0735-1097(85)80103-0","article-title":"Severe hypoxemia due to shunting through a patent foramen ovale: a correctable complication of right ventricular infarction","volume":"5","author":"Bansal","year":"1985","journal-title":"J Am Coll Cardiol"},{"key":"2026031602312501900_ytag140-B10","doi-asserted-by":"crossref","first-page":"443","DOI":"10.2143\/AC.57.6.2005471","article-title":"Arrhythmogenic right ventricular cardiomyopathy and atrial right-to-left shunt","volume":"57","author":"Cubero","year":"2003","journal-title":"Acta Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag140\/67203681\/ytag140.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/3\/ytag140\/67203681\/ytag140.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/3\/ytag140\/67203681\/ytag140.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T06:31:35Z","timestamp":1773642695000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag140\/8503764"}},"subtitle":[],"editor":[{"given":"Niklas","family":"Schenker","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Lucia","family":"Bobik","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag140","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2026,3]]},"article-number":"ytag140"}}