Postoperative development of platypnea-orthodeoxia syndrome due to patent foramen ovale in patients with cerebral infarction who were treated by thrombectomy

Abstract

We report two cases of hypoxemia when standing (platypnea-orthodeoxia syndrome, POS) that occurred in patients who had undergone thrombectomy for cerebral infarction, and in whom patent foramen ovale (PFO) was discovered postoperatively. Case 1: A 56-year-old woman underwent thrombectomy for right middle cerebral artery occlusion following an episode of loss of consciousness. Postoperatively, the patient had hypoxia that worsened when standing and was diagnosed with POS. A contrast-enhanced chest CT revealed PFO, and percutaneous closure of the PFO was performed in the cardiology department. Case 2: A 61-year-old man underwent thrombectomy for right middle cerebral artery occlusion after repeated episodes of loss of consciousness. The patient subsequently experienced significant hypoxia with deep breathing and was diagnosed with POS. A contrast-enhanced chest CT revealed PFO, and percutaneous closure of the PFO was performed in the cardiology department. POS is considered extremely rare at the onset of cerebral infarction; however, it is important to conduct a thorough examination in such patients to exclude the possibility of PFO.