Unexplained dyspnea in an old patient with recurrent stroke: platypnea-orthodeoxia syndrome and evidence of patent foramen ovale.

Platypnea-orthodeoxia is a syndrome characterized by dyspnea and hypoxemia in orthostatism relieved by supine position. This phenomenon is frequently associated with interatrial communication, mainly patent foramen ovale. The association of platypnea-orthodeoxia syndrome with recurrent stroke and patent foramen ovale is extremely uncommon. A 73-year-old woman experienced recurrent attacks of dyspnea after an ischemic stroke. Arterial blood gas analysis changes in upright and supine position confirmed the diagnosis of platypnea-orthodeoxia syndrome. Contrast-enhanced transthoracic echocardiography showed patent foramen ovale with atrial septal aneurysm and right-to-left shunt. Percutaneous closure of patent foramen ovale led to stabilization of blood oxygen saturation and resolution of dyspnea. Platypnea-orthodeoxia syndrome should be considered in patients with stroke and unexplained dyspnea. The diagnosis could lead to correction of an unknown cardiac defect and of potential risk factor for stroke.