{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:30:06Z","timestamp":1786714206759,"version":"build-2736575974"},"reference-count":17,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,28]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>Patent foramen ovale (PFO) is a common congenital cardiac anomaly, generally responsible for cryptogenic stroke. Still, it can cause severe positional hypoxia via a right-to-left shunt if associated with anatomic distortion of the interatrial septum. A man in his 90s with a known atrial septal defect (pulmonary blood flow\/systemic blood flow (Qp\/Qs) ratio of 0.85) and ascending aortic aneurysm presented with sudden worsening of chronic exertional dyspnoea and had profound hypoxia, requiring bilevel positive airway pressure. Workup was negative for pulmonary embolism with an unremarkable prior transthoracic echocardiogram (TTE). During hospitalisation, he was found to have worsening hypoxia in the upright position, which improved in the supine and right lateral decubitus positions. A repeat TTE with agitated saline was performed, which showed a PFO with a large right-to-left shunt, confirmed by transoesophageal echocardiogram (TEE), along with a severe atrial septum aneurysm on TEE. Percutaneous PFO closure with a 37\u2009mm Gore occluder resulted in immediate resolution of hypoxaemia and clinical improvement.<\/jats:p>","DOI":"10.1136\/bcr-2025-271548","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T12:40:28Z","timestamp":1786711228000},"page":"e271548","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Interplay of patent foramen ovale and atrial septum aneurysm in a nonagenarian patient presenting with platypnoea-orthodeoxia syndrome"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8121-083X","authenticated-orcid":false,"given":"Dhan Bahadur","family":"Shrestha","sequence":"first","affiliation":[{"name":"Division of Cardiology, Bassett Medical Center, Cooperstown, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3849-1880","authenticated-orcid":false,"given":"Prakash Raj","family":"Oli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois, USA"},{"name":"Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafain","family":"Meghani","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Bassett Medical Center, Cooperstown, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"2026081405401388000_19.8.e271548.1","article-title":"Patent Foramen Ovale Closure for Nonstroke Indications","volume":"2","author":"Honasoge","year":"2023","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"2026081405401388000_19.8.e271548.2","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-243589","article-title":"Platypnea-orthodeoxia syndrome in patent foramen ovale and fenestrated atrial septal aneurysm with normal right atrial pressure: what is the culprit?","volume":"14","author":"Pelayo","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2026081405401388000_19.8.e271548.3","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":"2026081405401388000_19.8.e271548.4","doi-asserted-by":"crossref","unstructured":"Verolino G . Platypnea-orthodeoxia syndrome and patent foramen ovale. A shared treatment pathway for young and elderly patients? Minerva Cardiol Angiol 2025. doi:10.23736\/S2724-5683.25.06958-3","DOI":"10.23736\/S2724-5683.25.06958-3"},{"key":"2026081405401388000_19.8.e271548.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaccas.2024.102439","article-title":"PFO Leading to Concomitant Platypnea-Orthodeoxia Syndrome and Stroke","volume":"29","author":"Mancini","year":"2024","journal-title":"JACC Case Rep"},{"key":"2026081405401388000_19.8.e271548.6","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMcps1803916","article-title":"A Dangerous Detour","volume":"380","author":"Berg","year":"2019","journal-title":"N Engl J Med"},{"key":"2026081405401388000_19.8.e271548.7","first-page":"e115","article-title":"2025 ACC\/AHA\/HRS\/ISACHD\/SCAI Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"153","author":"Davis","year":"2026","journal-title":"Circulation"},{"key":"2026081405401388000_19.8.e271548.8","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1007\/s10554-024-03217-5","article-title":"Age-dependent association between aneurysmal and isolated redundant inter-atrial septum with patent foramen ovale","volume":"40","author":"Zoroufian","year":"2024","journal-title":"Int J Cardiovasc Imaging"},{"key":"2026081405401388000_19.8.e271548.9","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.027508"},{"key":"2026081405401388000_19.8.e271548.10","doi-asserted-by":"crossref","first-page":"187","DOI":"10.14740\/jmc2840e","article-title":"Platypnea Orthodeoxia Syndrome in a Patient With Pulmonary Arterial Hypertension","volume":"8","author":"Sinanis","year":"2017","journal-title":"J Med Cases"},{"key":"2026081405401388000_19.8.e271548.11","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaccas.2025.104433","article-title":"Platypnea-Orthodeoxia Syndrome Due to Patent Foramen Ovale: A Diagnostic and Therapeutic Challenge","volume":"30","author":"Carrasquel-Alvarez","year":"2025","journal-title":"JACC Case Rep"},{"key":"2026081405401388000_19.8.e271548.12","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":"2026081405401388000_19.8.e271548.13","article-title":"Patent Foramen Ovale-Induced Platypnea-Orthodeoxia Syndrome: A Case Report and Literature Review","volume":"14","author":"Alotaibi","year":"2022","journal-title":"Cureus"},{"key":"2026081405401388000_19.8.e271548.14","doi-asserted-by":"crossref","unstructured":"DI Muro FM , Compagnone M , Santoro G , et al . Percutaneous closure of patent foramen ovale in patients with platypnea-orthodeoxia syndrome: an Italian multicenter experience. Minerva Cardiol Angiol 2025. doi:10.23736\/S2724-5683.25.06841-3","DOI":"10.23736\/S2724-5683.25.06841-3"},{"key":"2026081405401388000_19.8.e271548.15","article-title":"SCAI Guidelines for the Management of Patent Foramen Ovale","volume":"1","author":"Kavinsky","year":"2022","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"2026081405401388000_19.8.e271548.16","doi-asserted-by":"crossref","unstructured":"Apostolos A , Tsiachris D , Drakopoulou M , et al . Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management. 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