Patent foramen ovale echocardiography

Patent Foramen Ovale Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [3]

Overview

The performance of a bubble study on echocardiography is a simple diagnostic study of choice. Transesophageal echocardiography is more sensitive in visualizing the interatrial septum, than transthoracic echocardiography and is the imaging modality of choice.

Technique

Transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and transcranial Doppler (TCD) are the commonly used diagnostic tools for patent foramen ovale. Each method has its own advantage and disadvantages in diagnosing patent foramen ovale.

Transesophageal echocardiography

Advantage:

• Gold standard in diagnosing patent foramen ovale.

Disadvantage:

• The patent foramen ovale patients who have failed to be diagnosed with a doppler or a two-dimensional echo are sent for a bubble test. In bubble test sonicated microbubbles are injected in the antecubital vein. These bubbles first appear in the right atrium. If bubbles appear in the left atrium within three heart beats, then the study is considered diagnostic of a patent foramen ovale. On echocardiography, there may not be any shunting of blood (i.e. bubbles may not appear in the left atrium and ventricle) except when the patient coughs or performs the Valsalva maneuver. Release of Valsalva maneuver increases flow to the right atrium, and increases the transit of bubbles across the patent foramen ovale. In transesophageal echocardiography the bubble test might not show a shunt because of the following: requirement for patient sedation, positioning in the left decubitus position and the inability to perform a complete Valsalva.

Patent Foramen Ovale on Echocardiographic Bubble Study

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