[A strange case of acute respiratory failure: the platypnea-orthodeoxia syndrome]. / Un insolito caso di insufficienza respiratoria acuta: la sindrome platipnea-ortodeossia.

Platypnea-orthodeoxia syndrome is a rare disorder characterized by dyspnea and oxygen desaturation in upright position, with improvement of symptoms and blood oxygenation in supine position. Basically a right-to-left shunt (intracardiac or pulmonary) or a ventilation/perfusion mismatch are necessary to develop platypnea-orthodeoxia syndrome. Atrial septal defects, including patent foramen ovale (PFO), are known to be a frequent cause of platypnea-orthodeoxia syndrome. We describe herein the case of a 79-year-old woman with platypnea-orthodeoxia syndrome and PFO who developed a refractory worsening respiratory failure. Only the "rescue" emergency closure of PFO allowed the patient a clinical turning point with immediate and sustained respiratory improvement.

Simple versus complex approaches to treating coronary bifurcation lesions: direct assessment of stent strut apposition by optical coherence tomography.

INTRODUCTION AND OBJECTIVES: Stenting of coronary bifurcation lesions carries an increased risk of stent deformation and malapposition. Anatomical and pathological observations indicate that the high stent thrombosis rate in bifurcations is due to malapposition of stent struts. METHODS: Strut apposition was assessed with optical coherence tomography (OCT) in bifurcation lesions treated either using the simple technique of stent implantation in the main vessel only or a complex technique (i.e. Culotte's). A strut was regarded as malapposed if the gap between its endoluminal surface and the vessel wall was greater than its thickness plus an OCT resolution error margin of 15 microm. RESULTS: Simple and complex (i.e. Culotte's) approaches were used in 17 and 14 patients, respectively. Strut malapposition was significantly more frequent for the half of the bifurcation on same side as the vessel side branch (median, 46.1%; interquartile range [IQR], 35.3-62.5%) than for the half opposite the side branch (9.1%; IQR, 2.2-21.6%), the distal segment (7.5%; IQR, 2.3-20.2%) or the proximal segment (12.6%; IQR, 7.8-23.1%; P< .0001); the gap between strut and vessel wall in malapposed struts was significantly greater in the first segment than the others: 98 microm (IQR, 37-297 microm) vs. 31 microm (IQR, 13-74 microm), 49 microm (IQR, 20-100 microm) and 38 microm (IQR, 17-90 microm), respectively (P< .0001). Using the complex technique had no effect on the prevalence of strut malapposition in the four segments relative to the simple technique (P=.31) but was associated with a smaller gap in the proximal segment (47 microm vs. 60 microm; P=.0008). CONCLUSIONS: In coronary bifurcation lesions, strut malapposition occurred most frequently and was most significant close to the side branch ostium. The use of Culotte's technique did not significantly increase the prevalence of strut malapposition compared with a simple technique.

Estrategia simple o compleja para lesiones de bifurcaciones coronarias: evaluación inmediata de la aposición de los struts del stent mediante tomografía de coherencia óptica / Simple versus complex approaches to treating coronary bifurcation lesions: direct assessment of stent strut apposition by optical coherence tomography

Introducción y objetivos. La implantación de stents en lesiones de bifurcaciones coronarias comporta un riesgo elevado de deformación y mala aposición del stent. Las observaciones anatomopatológicas han atribuido a la mala aposición de los struts un papel causal en la elevada tasa de trombosis de los stents que se observa en las bifurcaciones. Métodos. Se evaluó la aposición de los struts en las lesiones de bifurcaciones tratadas con una técnica simple de implantación de stent solo en el vaso principal o con una técnica compleja (de culotte) mediante el empleo de tomografía de coherencia óptica (OCT). La mala aposición de un strut se definió por el hecho de que la distancia entre su superficie intraluminal y la pared vascular fuera superior a su grosor más un margen de error de resolución de la OCT de 15 μm. Resultados. En 17 pacientes se utilizó la estrategia simple y en 14, la técnica compleja (de culotte). Los struts con mala aposición fueron significativamente más frecuentes y la distancia entre el strut y la pared vascular en los casos de mala aposición fue mayor en la mitad de la bifurcación situada hacia la rama lateral (RL) (46,1% [35,3-62,5]) en comparación con la mitad del lado opuesto (9,1% [2,2-21,6]), el segmento distal (7,5% [2,3-20,2]) y el segmento proximal (12,6% [7,8-23,1]; p < 0,0001) (distancias, 98 μm [37-297] frente a 31 μm [13-74], 49 μm [20-100] y 38 μm [17-90], respectivamente; p < 0,0001). El empleo de la técnica compleja no afectó a la prevalencia de struts con mala aposición en los 4 segmentos en comparación con la estrategia simple (p = 0,31) y se asoció a una menor distancia strut-pared en el segmento proximal (47 frente a 60 mm; p = 0,0008). Conclusiones. En las lesiones de bifurcaciones coronarias, la mala aposición de los struts se produce con mayor frecuencia y es más importante en la zona de origen de la RL. El empleo de la técnica de culotte no aumenta de manera significativa la prevalencia de la mala aposición de los struts en comparación con una estrategia simple (AU)

Introduction and objectives. Stenting of coronary bifurcation lesions carries an increased risk of stent deformation and malapposition. Anatomical and pathological observations indicate that the high stent thrombosis rate in bifurcations is due to malapposition of stent struts. Methods. Strut apposition was assessed with optical coherence tomography (OCT) in bifurcation lesions treated either using the simple technique of stent implantation in the main vessel only or a complex technique (i.e. Culotte’s). A strut was regarded as malapposed if the gap between its endoluminal surface and the vessel wall was greater than its thickness plus an OCT resolution error margin of 15 µm. Results. Simple and complex (i.e. Culotte’s) approaches were used in 17 and 14 patients, respectively. Strut malapposition was significantly more frequent for the half of the bifurcation on same side as the vessel side branch (median, 46.1%; interquartile range [IQR], 35.3–62.5%) than for the half opposite the side branch (9.1%; IQR, 2.2–21.6%), the distal segment (7.5%; IQR, 2.3–20.2%) or the proximal segment (12.6%; IQR, 7.8–23.1%; P<.0001); the gap between strut and vessel wall in malapposed struts was significantly greater in the first segment than the others: 98 µm (IQR, 37–297 µm) vs. 31 µm (IQR, 13–74 µm), 49 µm (IQR, 20–100 µm) and 38 µm (IQR, 17–90 µm), respectively (P<.0001). Using the complex technique had no effect on the prevalence of strut malapposition in the four segments relative to the simple technique (P=.31) but was associated with a smaller gap in the proximal segment (47 µm vs. 60 µm; P=.0008). Conclusions. In coronary bifurcation lesions, strut malapposition occurred most frequently and was most significant close to the side branch ostium. The use of Culotte’s technique did not significantly increase the prevalence of strut malapposition compared with a simple technique (AU)