# Anesthetic management of Platypnea–orthodeoxia syndrome in a young patient with residual atrial septal defect following congenital heart surgery

## TL;DR

A young patient with a heart defect causing breathing and oxygen issues was successfully treated with careful anesthetic and monitoring techniques.

## Contribution

This case highlights anesthetic strategies for managing POS in young patients with residual ASD after congenital heart surgery.

## Key findings

- Right-to-left shunting in POS was confirmed using agitated saline contrast echocardiography.
- Anesthetic techniques focused on maintaining vascular resistance and optimizing ventilation to reduce shunt flow.
- Percutaneous ASD closure was successfully performed with continuous monitoring.

## Abstract

Platypnea–orthodeoxia syndrome (POS) is a rare condition causing dyspnea and hypoxemia that worsen in the upright position and improve when supine. While often reported in elderly patients, POS in young adults, particularly due to residual atrial septal defects (ASD) after congenital heart surgery, is uncommon.

We present a 24-year-old woman with POS caused by a residual ASD following congenital heart surgery. Agitated saline contrast transthoracic echocardiography confirmed marked right-to-left shunting exacerbated by positional change and Valsalva maneuver.

Anesthetic management focused on minimizing shunt flow by maintaining systemic vascular resistance, avoiding hypoxia, hypercarbia, and acidosis, and carefully adjusting ventilation parameters. Transesophageal echocardiography was utilized for shunt evaluation and device placement. Additionally, continuous cerebral oximetry was monitored for possible ischemic changes associated with paradoxical embolisms. The patient underwent successful percutaneous ASD closure without complications.

This rare case of young-onset POS highlights the importance of understanding the dynamic shunt physiology and vigilant intraoperative monitoring to ensure patient safety.

The online version contains supplementary material available at 10.1186/s40981-025-00844-2.