Atrial septal defect contrast echocardiography

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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], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]

Overview

Echocardiography is the preferred diagnostic tool in the evaluation of an atrial septal defect. Contrast echocardiography is an effective modality that can be performed in individuals with a suspected atrial septal defect which is not visualized definitively on transthoracic imaging.

Contrast echocardiography

• Used to determine the presence of intercardiac shunting often seen in the apical four chamber view
• Agitated saline is commonly used as the contrast material.

• Injected into a peripheral vein during echocardiography, small air bubbles can be seen on the imaging.
• It may be possible to see bubbles travel across an atrial septal defect either at rest or during a cough.
• Bubbles will only flow from right atrium to left atrium if the RA pressure is greater than LA

Common Findings

• A right-to-left interatrial shunt can be seen:

• When an atrial septal defect with accompanying pulmonary hypertension, resulting in a left-to-right reversal.
• Any time a patent foramen ovale defect is present.
• When an uncomplicated atrial septal defect has an imbalance in right-sided pressure, such as from coughing or the Valsalva maneuver.
• When an uncomplicated atrial septal defect has a momentary onset of left ventricular contraction.

Sensitivity

• Not recommended for:

• Left-to-right interatrial shunt diagnosis
• Pregnant patients
• Patients with severe pulmonary hypertension

Disadvantages

• False positives in the setting of a pulmonary arteriovenous malformation.
• Difficulty in quantifying the size of the shunt