Multiple vertebral fractures precipitate a platypnea-orthodeoxia syndrome in a patient with atrial septal defect and aortic root dilatation: when the upright position becomes intolerable

Platypnea-orthodeoxia syndrome is a rare disease characterized by dyspnea and oxygen desaturation induced by the upright position and relieved by recumbency. We report a case of 65- years old woman with a recent history of traumatic hip and multiple vertebral fractures referred to our Institute due to onset of severe acute dyspnea. Trans-thoracic and trans-oesophageal echocardiography, conducted by intravenous administration of agitated saline contrast solution, revealed the presence of Atrial Septal Defect (ASD) associated with an important bidirectional shunting that was right-to-left directed when the patient was in sitting position. Surgical closure of ASD resulted in resolution of the syndrome