Scientific Letter
Effective Treatment of Platypnea-Orthodeoxia and Severe Hypoxemia
Tratamiento efectivo en ortodeoxia e hipoxemia grave
Read
1923
Timeswas read the article
563
Total PDF
1360
Total HTML
Share statistics
array:23 [ "pii" => "S1579212920300562" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.11.007" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "2326" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:333-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289619305769" "issn" => "03002896" "doi" => "10.1016/j.arbres.2019.11.009" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "2326" "copyright" => "The Author(s)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:333-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 148 "formatos" => array:3 [ "EPUB" => 22 "HTML" => 100 "PDF" => 26 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta Científica</span>" "titulo" => "Tratamiento efectivo en ortodeoxia e hipoxemia grave" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "333" "paginaFinal" => "334" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Effective Treatment of Platypnea-Orthodeoxia and Severe Hypoxemia" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 560 "Ancho" => 750 "Tamanyo" => 45289 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Corte axial con contraste intravenoso. Se observa una mayor captación de contraste en circulación sistémica comparado con arterias pulmonares y con presencia de contraste en vena cava superior. También se observa dilatación de la aorta ascendente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier Navarro Esteva, José Ramón Ortega Trujillo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Navarro Esteva" ] 1 => array:2 [ "nombre" => "José Ramón" "apellidos" => "Ortega Trujillo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212920300562" "doi" => "10.1016/j.arbr.2019.11.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920300562?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619305769?idApp=UINPBA00003Z" "url" => "/03002896/0000005600000005/v2_202005050648/S0300289619305769/v2_202005050648/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212920300574" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.10.005" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "2327" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:334-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Small bowel perforation due to metastatic pleomorphic lung cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "334" "paginaFinal" => "335" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis de carcinoma pulmonar pleomórfico como causa de abdomen agudo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 449 "Ancho" => 1255 "Tamanyo" => 88742 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) CT slice showing the scan of the lung cancer tumor mass responsible for intussusception and subsequent perforation. b) Intraoperative Image of the tumor showing intestinal perforation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier Varela Recio, Violeta Camacho Marente, Ana Triviño Ramirez, Dionisio Espinosa Jimenez, Jose Manuel Pacheco Garcia" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Varela Recio" ] 1 => array:2 [ "nombre" => "Violeta" "apellidos" => "Camacho Marente" ] 2 => array:2 [ "nombre" => "Ana" "apellidos" => "Triviño Ramirez" ] 3 => array:2 [ "nombre" => "Dionisio" "apellidos" => "Espinosa Jimenez" ] 4 => array:2 [ "nombre" => "Jose Manuel" "apellidos" => "Pacheco Garcia" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289619305770" "doi" => "10.1016/j.arbres.2019.10.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619305770?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920300574?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000005/v2_202101220640/S1579212920300574/v2_202101220640/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1579212920300550" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.11.006" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "2325" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:331-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "<span class="elsevierStyleItalic">Mycobacterium peregrinum</span>: An atypical and uncommon <span class="elsevierStyleItalic">Mycobacterium</span>. A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "331" "paginaFinal" => "332" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Mycobacterium peregrinum</span>: micobacteria atípica e infrecuente. Reporte de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 940 "Ancho" => 1255 "Tamanyo" => 171224 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Chest CT scan at the time of diagnosis. B. Follow-up chest CT scan after completing the antibiotic treatment.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nicolás Rolan, Leticia Limongi, Ana María Putruele" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Rolan" ] 1 => array:2 [ "nombre" => "Leticia" "apellidos" => "Limongi" ] 2 => array:2 [ "nombre" => "Ana María" "apellidos" => "Putruele" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289619305757" "doi" => "10.1016/j.arbres.2019.11.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619305757?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920300550?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000005/v2_202101220640/S1579212920300550/v2_202101220640/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Effective Treatment of Platypnea-Orthodeoxia and Severe Hypoxemia" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "333" "paginaFinal" => "334" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Navarro Esteva, José Ramón Ortega Trujillo" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Javier" "apellidos" => "Navarro Esteva" "email" => array:1 [ 0 => "jnesteva7@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José Ramón" "apellidos" => "Ortega Trujillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital San Roque Maspalomas, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento efectivo en ortodeoxia e hipoxemia grave" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 755 "Ancho" => 1008 "Tamanyo" => 72148 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial slice with intravenous contrast. Greater contrast enhancement can be observed in the systemic circulation compared to the pulmonary arteries, with presence of contrast in the superior vena cava. Dilation of the ascending aorta can also be observed.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Patent foramen ovale (PFO) is present in 10%–36% of the population. It is associated with minimal left-to-right shunting, although a transient right-to-left gradient may appear in early ventricular systole caused by a Valsalva maneuver – coughing, lifting heavy objects, or defecating. However, the clinical effect of right-to-left shunting through the PFO occurs only occasionally, and may present as a paradoxical embolism (e.g. stroke) or, more rarely, as platypnea-orthodeoxia syndrome (POS), with or without embolism. Cases of POS should be due not only to PFO, but also to the presence of an acquired abnormality. Thus, an anatomical defect in the form of interatrial communication should coexist with another functional defect that causes a change in direction of the blood flow when adopting a sitting or standing position.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1,2</span></a> In this respect, it is important to note that POS has also been described in patients with pneumonectomy, intrapulmonary vascular malformations, right diaphragmatic paralysis, pericardial effusion, constrictive pericarditis, emphysema, cirrhosis, and amiodarone-induced lung disease.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 76-year-old man with a history of obesity, prostate cancer, and vertebrobasilar and cerebellar stroke 5 years previously with no sequelae, unconfirmed suspected sleep apnea-hypopnea syndrome (SAHS) and <span class="elsevierStyleItalic">ostium secundum</span>-type interatrial communication. He presented with dyspnea and hypoxemia that had commenced a few months before admission, for which he was prescribed home oxygen, although the cause of the hypoxemia was never determined. At the time of admission, he had dyspnea at rest and presented disorientation and agitation, central cyanosis, tachypnea, inspiratory crackles in the right base and posterior plane, normal heart sounds with no signs of right overload and severe hypoxemia without hypercapnia. Chest radiograph showed no infiltrates, and pulmonary embolism was ruled out by computed tomography (CT) angiography, observing only some laminar atelectasia in dependent segments. Nevertheless, it was noted that the contrast density was higher in the aorta than in the pulmonary artery, despite the presence of residual contrast in the vena cava; it was also observed that the ascending aorta was dilated (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Arterial blood gas analysis with oxygen delivered by nasal cannula at a flow rate of 4<span class="elsevierStyleHsp" style=""></span>Lpm in decubitus showed pH: 7.42; PaCO<span class="elsevierStyleInf">2</span>: 38<span class="elsevierStyleHsp" style=""></span>mmHg; PaO<span class="elsevierStyleInf">2</span>: 56<span class="elsevierStyleHsp" style=""></span>mmHg; HCO<span class="elsevierStyleInf">3</span>: 25<span class="elsevierStyleHsp" style=""></span>mEquiv./L; and SaO<span class="elsevierStyleInf">2</span>: 89%. Transthoracic echocardiography (TTE) found good biventricular function with abnormal left ventricular relaxation, with no indirect signs of interatrial communication or pulmonary hypertension.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Application of noninvasive mechanical ventilation (NIMV) with FiO<span class="elsevierStyleInf">2</span> >60% did not significantly change the hypoxemia. However, when the patient was moved to a sitting position in the bed, he presented rapid hemoglobin desaturation. Agitated saline transesophageal echocardiography (TEE) showed the passage of a large number of bubbles from the right to the left atrium through a wide PFO, with filling of almost 80% of the left atrium in sitting position. We also observed a significant 25-mm displacement of the interatrial septum and a 45-mm dilation of the aortic root. Although it has been reported that performing TEE under NIMV support may be safer than conventional low oxygen therapy,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> hypoxemia was well tolerated and it was decided to perform the procedure with nasal cannula at 6<span class="elsevierStyleHsp" style=""></span>Lpm. Finally, percutaneous closure of the PFO with an Occlutech® Figulla® device No. 30 (Occlutech GmbH, Jena, Germany) was performed, with clinical improvement being evident after the procedure. The patient was discharged without requiring oxygen therapy. Seven years after implantation of the occluder, correct placement of the device and absence of significant hypoxemia were confirmed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this case, we believe that dilation of the aortic root was the acquired factor. This finding has been published by different groups.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1,2,5,6</span></a> It should also be mentioned that the presence of atelectasia worsened the hypoxemia, and although the SAHS was not confirmed, it has been reported that patients with SAHS and PFO can experience more desaturations in proportion to respiratory events than patients without PFO.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Furthermore, we believe that the absence of echocardiographic signs of pulmonary hypertension increased the probability of successful closure.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the case of a diagnosis of POS that cannot be explained by any other cause, even when TTE does not suggest shunting, a dynamic TEE should be performed in both the supine and sitting position, with or without a Valsalva maneuver. Another method for diagnosing right-to-left shunting is transcranial Doppler ultrasound, although TEE is preferred as it enables the site of the shunting to be confirmed and proper evaluation of the defect.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In various published case series, percutaneous closure of the PFO has effectively resolved the POS.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1,5,6,8–10</span></a> Monitoring the procedure by TEE is invaluable, as it allows us to confirm the optimal device size, check the absence of leaks once positioned—enabling it to be repositioned and/or removed if it does not fit properly—and to rule out procedural complications. Complications during and after implantation, though rare, can include: embolisms, infections, arrhythmias, device thrombosis, large persistent residual shunts, and traumatic fistulas between the aorta and left atrium, an event facilitated in cases of aortic aneurysm.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, it should be mentioned that in cases of PFO and pulmonary hypertension, closure is controversial because of the risk of right ventricular failure.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> Nevertheless, there are reports of patients with chronic obstructive pulmonary disease and PFO with right-to-left shunting studied by pulmonary catheterization, in whom the administration of both oxygen and inhaled nitric oxide produced a significant vasodilatory response together with improved oxygenation. In one such case, hypoxemia was resolved by percutaneous closure of the shunt, and in another, a significant improvement was noted following the administration of a phosphodiesterase-5 inhibitor.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navarro Esteva J, Ortega Trujillo JR. Tratamiento efectivo en ortodeoxia e hipoxemia grave. Arch Bronconeumol. 2020;56:333–334.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 755 "Ancho" => 1008 "Tamanyo" => 72148 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial slice with intravenous contrast. Greater contrast enhancement can be observed in the systemic circulation compared to the pulmonary arteries, with presence of contrast in the superior vena cava. Dilation of the ascending aorta can also be observed.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac platypnea-orthodeoxia syndrome: a «mysterious» cause of hypoxemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Sabater Abad" 1 => "G. Samper Juan" 2 => "R. Payá Serrano" 3 => "J.L. Pérez Boscá" 4 => "M. Ramón Capilla" 5 => "E. Fernandez Fabrellas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2016.02.003" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "494" "paginaFinal" => "495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26975978" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patent foramen ovale: current state of the art" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Cruz-Gonzalez" 1 => "J. Solis" 2 => "I. Inglessis-Azuaje" 3 => "I.F. Palacios" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2008" "volumen" => "61" "paginaInicial" => "738" "paginaFinal" => "751" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18590647" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0075" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory failure associated with diaphragmatic paralysis: just a ventilation/perfusion problem?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Benito-González" 1 => "F. Díez-Fernández" 2 => "A. Pérez de Prado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2016.03.002" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "566" "paginaFinal" => "567" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27107666" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109799005082" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0080" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive ventilation during endoscopic procedures: rationale, clinical use, and devices" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Pieri" 1 => "G. Landoni" 2 => "L. Cabrini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2017.09.038" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2018" "volumen" => "32" "paginaInicial" => "928" "paginaFinal" => "934" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29317119" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0085" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.R. Ortega Trujillo" 1 => "J. Suárez de Lezo Herreros de Tejada" 2 => "A. García Quintana" 3 => "F. Melián Nuez" 4 => "R. Rodríguez Delgado" 5 => "A. Medina Fernández-Aceytuno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1157/13084451" "Revista" => array:7 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2006" "volumen" => "59" "paginaInicial" => "78" "paginaFinal" => "81" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16540023" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673600041519" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0090" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platypnea-orthodeoxia due to aortic elongation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Medina" 1 => "J.S. de Lezo" 2 => "E. Caballero" 3 => "J.R. Ortega" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/hc3101.093603" "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2001" "volumen" => "104" "paginaInicial" => "741" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11489786" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0095" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PFO and right-to-left shunting in patients with obstructive sleep apnea" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Guchlerner" 1 => "P. Kardos" 2 => "E. Liss-Koch" 3 => "J. Franke" 4 => "N. Wunderlich" 5 => "S. Bertog" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5664/jcsm.2026" "Revista" => array:6 [ "tituloSerie" => "J Clin Sleep Med" "fecha" => "2012" "volumen" => "8" "paginaInicial" => "375" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22893767" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0100" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter closure of patent foramen ovale: a definitive treatment for platypnea-orthodeoxia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.O. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1522-726x(200009)51:1<120::aid-ccd27>3.0.co;2-d" "Revista" => array:5 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2000" "volumen" => "51" "paginaInicial" => "120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10973034" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0105" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of platypnea-orthodeoxia syndrome by transcatheter closure of atrial communication: hemodynamic characteristics, clinical and echocardiographic outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Delgado" 1 => "I. Inglessis" 2 => "F. Martin-Herrero" 3 => "D. Yoerger" 4 => "R. Liberthson" 5 => "F. Buoanno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Invasive Cardiol" "fecha" => "2004" "volumen" => "16" "paginaInicial" => "578" "paginaFinal" => "582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15505355" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0110" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia: results of a multicentric French registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Guerin" 1 => "V. Lambert" 2 => "F. Godart" 3 => "A. Legendre" 4 => "J. Petit" 5 => "F. Bourlon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00270-004-0035-3" "Revista" => array:6 [ "tituloSerie" => "Cardiovasc Intervent Radiol" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "164" "paginaFinal" => "168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15719178" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0115" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Potential role of patent foramen ovale in exacerbating hypoxemia in chronic pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.E. Layoun" 1 => "J.A. Aboulhosn" 2 => "J.M. Tobis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.14503/THIJ-16-6027" "Revista" => array:6 [ "tituloSerie" => "Tex Heart Inst J" "fecha" => "2017" "volumen" => "44" "paginaInicial" => "189" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28761399" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0120" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac shunt in COPD as a cause of severe hypoxaemia: probably not so uncommon after all" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.G. Boerrigter" 1 => "A. Boonstra" 2 => "N. Westerhof" 3 => "P.E. Postmus" 4 => "A. Vonk-Noordegraaf" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00058410" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "960" "paginaFinal" => "962" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21454898" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005600000005/v2_202101220640/S1579212920300562/v2_202101220640/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005600000005/v2_202101220640/S1579212920300562/v2_202101220640/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920300562?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 85 | 17 | 102 |
| 2024 September | 79 | 16 | 95 |
| 2024 August | 110 | 34 | 144 |
| 2024 July | 90 | 22 | 112 |
| 2024 June | 103 | 30 | 133 |
| 2024 May | 114 | 28 | 142 |
| 2024 April | 55 | 22 | 77 |
| 2024 March | 51 | 15 | 66 |
| 2024 February | 50 | 20 | 70 |
| 2023 November | 2 | 0 | 2 |
| 2023 June | 1 | 0 | 1 |
| 2023 March | 10 | 2 | 12 |
| 2023 February | 67 | 15 | 82 |
| 2023 January | 46 | 33 | 79 |
| 2022 December | 66 | 27 | 93 |
| 2022 November | 63 | 24 | 87 |
| 2022 October | 59 | 28 | 87 |
| 2022 September | 53 | 25 | 78 |
| 2022 August | 36 | 35 | 71 |
| 2022 July | 40 | 33 | 73 |
| 2022 June | 40 | 32 | 72 |
| 2022 May | 43 | 29 | 72 |
| 2022 April | 38 | 21 | 59 |
| 2022 March | 31 | 28 | 59 |
| 2022 February | 15 | 23 | 38 |
| 2021 April | 1 | 0 | 1 |
| 2021 February | 2 | 0 | 2 |
| 2021 January | 1 | 2 | 3 |
| 2020 May | 1 | 0 | 1 |
| 2020 April | 8 | 2 | 10 |
Show all
