An isolated desaturation after a surgery: diagnostic of a platypnea-orthodeoxia syndrom

Patent foramen oval is a frequent anomaly. When it affects intracardiac haemodynamics, it causes the rare and little known platypnea-orthodeoxia syndrome. We describe here a case of this syndrome occurring following orthopaedic surgery. The on-duty anaesthesiologist was called because an elderly woman hospitalised following orthopaedic surgery was suffering from isolated desaturation. Her main past medical history was chronic respiratory insufficiency caused by thromboembolic disease. Moving the patient and volume expansion led to variations in haematosis (supine position and filling test with colloid increased saturation). A transesophageal ultrasound showed a patent foramen oval. It was closed a few days later percutaneously with a spectacular result on the dyspnoea. Platypnea-orthodeoxia syndrome is a rare cause of a refractory dyspnoea and is important to identify. The closing procedure has a success rate close to 100% and procures spectacular clinical results.