Patent foramen ovale closure for platypnea-orthodeoxia syndrome in a tertiary center in Portugal

Abstract Background Platypnea-Orthodeoxia Syndrome (POS) may occur because of right-to-left intracardiac shunt in patients with Patent Foramen Ovale (PFO) and pathology leading to distortion of the area, namely aneurism or elongation of the ascending aorta, spinal kyphosis, prominent Eustachian valve or extrinsic compression of the right atrium. Purpose To analyze the population of POS patients undergoing PFO closure from January 2020 to October 2025. Methods Descriptive retrospective study of patients submitted to PFO closure for POS from January 2020 to October 2024. Results In the analyzed period there were 234 PFO closures, of which 17 (7.3%) where performed because of POS. Of these procedures performed for POS, most (13 — 76.5%) were in women, and 4 in men. Mean age was 74.6 ± 13.0 years. The most prevalent cardiovascular risk factors were dyslipidemia (10 — 58.8%) and arterial hypertension (8 — 47.1%). One patient had POS because of previous lobectomy with distortion of the mediastinum; nine patients had ascending aorta dilation. Six closures were elective; eleven were non-elective, in hospitalized patients. In most procedures (14 — 82.4%), a bi-disk device was used, according to PFO anatomy, and in 3 cases a suture system was used. Hematoma in the venous access location occurred in one patient; stress cardiomyopathy occurred in another patient; two patients were hospitalized in our hospital and died (75-to-84-year-old patients with infectious diseases) and one other patient died in the follow-up. During follow-up, there was no de novo atrial fibrillation, stroke, major vascular complication, myocardial infarction, pericardial effusion or device embolization. Among the 16 patients with at least 6 months of follow-up, 3 had small and asymptomatic residual shunt. Conclusions In our sample, POS with indication for closure occurred more frequently in elderly women. Although PFO closure in older patients with more comorbidities is associated with greater risk of periprocedural complications and long-term adverse effects, in this sample the safety of this procedure in this subpopulation was demonstrated.