Figure 1.

Platypnea-Orthodeoxia Syndrome after transcatheter aortic valve implantation. (a) Cardiac Magnetic Resonance 4-Chamber Image from 4 years earlier, showing thinned and bulging interatrial septum (red arrow) with no evidence of aneurysm or transseptal contrast flow, right ventricular thickness = 7 mm, and mild tricuspid incompetence with no evidence of carcinoid infiltration. (b) Fluoroscopy imaging showing 35 mm septal occlusion device in situ before deployment, with Edwards S3™ 29 mm transcatheter aortic valve device and transoesophageal probe visible. (c) Intraoperative transoesophageal contrast study showing a large shunt from right-to-left atrium, possibly with the presence of more than one fenestrated defect. (d) Three-dimensional transoesophageal image of defect (red arrow) and transcatheter aortic valve in situ. (e) Three-dimensional transoesophageal showing PFO device in situ. (f) Postprocedure negative bubble study with device in situ.