148: Impact of patent foramen ovale closure in patients with platypnea-orthodeoxia syndrome

Platypnea orthodeoxia syndrome (POS) is a rare condition with right to left shunting through a Patent Foramen Ovale (PFO) that results in oxygen desaturation during postural changes. Few series are available on the functional status after PFO closure. The aim of our study was to describe the impact of PFO closure in this population. Methods We retrospectively included 24 consecutive patients with dyspnea related to POS, aged 73.6±9.6 years old (min 52, max 86, 62.5% male) who were referred for PFO closure between Oct. 2006 and july 2011 in the Toulouse Rangueil universitary hospital. Follow-up data were available in May 2012. Results At baseline, all patients had dyspnea (58.3% NYHA 4). Eight patients (33.3%) had a history of stroke attack. POS was related to right pneumonectomy in 3 patients (12.5%), ascending aortic ectasy in 11 patients (45.8%), hepato-renal polycystic disease in 2 patients (8.3%). Aneurysm of the inter-atrial septum was observed in 12 patients (50%). PaO2 was lower in erect position compared to recumbent position (50.4±6.8 versus 72.6±12.5 mmHg, p=0.0005). Closure of the PFO was performed percutaneously in 24 patients (100%). An additional surgical PFO closure was necessary in 1 patient because of significant residual shunting. PaO2 in erect position was significantly increased after closure (p=0.0254). During follow-up, 4 patients (16.7%, p=0.125) had a complete relief of their symptoms after closure. Dyspnea was significantly improved according to NYHA functional class (p=0.023). General status improved in 75% patients (p=0.025). Eight patients died (33.3%). Four deaths (50%) were related to stroke attacks at respectively 18 days, 3,11 and 39 months after PFO closure. Four deaths were not related to cardiac issue. Conclusion Patients referred for PFO closure for POS are old and at high risk of mortality, particularly from stroke attacks. PFO closure is associated with an improvement of the functional NYHA class and of the general status.