Patent foramen ovale presenting with platypnoea-orthodeoxia syndrome and stroke after multi-organ resection

Platypnoea-orthodeoxia syndrome (POS) is defined by oxygen desaturation and dyspnoea in upright position that improves by lying down. It results from a right to left shunt at the intracardiac or intrapulmonary level. A 53-year-old ovarian cancer patient presented with POS that was refractory to oxygen therapy. The symptoms began after an extensive abdominal and pelvic surgery as treatment of her cancer with a complex hospital course. A patent foramen ovale was found with the use of transoesophageal echocardiography. A percutaneous closure was done with positive outcome and dyspnoea disappearance. In this case with its challenging clinical setting, we present a unique clinical scenario of an immediate postoperative POS syndrome. We address the different therapeutic modalities and the need for a multidisciplinary medical approach.