Patent Foramen Ovale Closure in a Nonagenarian With Platypnoea-Orthodeoxia Syndrome

Patent foramen ovale (PFO) is a common congenital cardiac abnormality that affects one-quarter of the general population. Hypoxaemia, because large right-to-left shunt, rare complication PFO and occurs under exceptional physiological conditions. Case: This 90-year-old lady presented with progressive dyspnoea over several months. At presentation to hospital, she was hypoxaemic pO2 53 mmHg oxygen saturation 89% despite 15L via mask. While lying supine for computed tomography pulmonary angiogram (CTPA), it noted her normalised. The CTPA excluded embolus intrapulmonary vascular anomaly. Intermittent intracardiac shunt suspected confirmed on formal testing fraction calculated at 32%. Transthoracic echocardiogram CT failed demonstrate an shunt. Transoesophageal dynamic shunting colour Doppler agitated saline. She underwent percutaneous closure 25-mm Amplatzer Occluder, good procedural result resolution symptoms. 2-month follow-up remained well no breathlessness device-related complications. case illustrates unusual cause platypnoea-orthodeoxia syndrome due in nonagenarian. It hypothesised prominent Eustachian valve, anatomical factors including enlarged tortuous aorta pectus excavatum, had gradually progressed time, distorting anatomy, contributing significant shunting. Percutaneous resulted immediate symptomatic benefit.