Original articleA Critical Review of Patent Foramen Ovale Detection Using Saline Contrast Echocardiography: When Bubbles Lie
Section snippets
Microbubble Origin
Early investigators like Kremkau et al5 were among those whose in vitro experiments with distilled water, saline, and sucrose solution suggested that microbubble formation is caused by cavitation. When fluids are rapidly injected through a catheter, the hydrostatic pressure at the tip of the catheter is reduced, allowing dissolved gas to come out of solution to form transient microbubbles. It was demonstrated in subsequent experiments by Ziskin et al6 that almost any fluid, if rapidly injected
Clinical use of saline contrast in identification of shunt
Saline contrast use has been described for identification of cardiac structures,3 evaluation of complex congenital heart disease,13 enhancement of intracardiac Doppler signals,14 and needle localization during percutaneous drainage of pericardial effusion.15 Its most common use, however, has been in the detection of intracardiac shunt. With evolving interest in percutaneous closure of intracardiac defects, there is increasing reliance on the use of saline contrast echocardiography in clinical
What Quantity of Left Heart Contrast is Abnormal?
Since the origin of the 3-beat rule, there has been wide variation among investigators as to what quantity of LA contrast must appear before diagnosing the presence of a PFO. In 1994, when describing the use of TEE for identification of PFO, Homma et al30 defined as little as one microbubble in the LA to be abnormal during a saline contrast study. Mas et al,21 from the PFO and Atrial Septal Aneurysm Study Group, and Martin et al,31 studying the effects of PFO closure, required the presence of
References (52)
- et al.
Comparison of transesophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale
Am Heart J
(1994) - et al.
Why do the lungs clear ultrasonic contrast?
Ultrasound Med Biol
(1980) - et al.
Experimental studies of the dissolution of gas bubbles in whole blood and plasma, IImoving bubbles or liquids
J Biomech
(1971) - et al.
Enhanced detection of right-to-left shunt through patent foramen ovale by transthoracic contrast echocardiography using harmonic imaging
Am J Cardiol
(2001) - et al.
Transthoracic echocardiography using second harmonic imagingdiagnostic alternative to transesophageal echocardiography for the detection of atrial right to left shunt in patients with cerebral embolic events
J Am Coll Cardiol
(1999) - et al.
Contrast two-dimensional echocardiography in congenital heart diseasetechniques, indications and clinical utility
J Am Coll Cardiol
(1989) - et al.
Saline contrast enhancement of tricuspid regurgitant jets detected by Doppler color flow imaging
Am J Cardiol
(1990) - et al.
Differential diagnosis between patent foramen ovale and pulmonary arteriovenous fistula in two patients with previous cryptogenic stroke caused by presumed paradoxical embolism
J Am Soc Echocardiogr
(2002) - et al.
Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke
J Am Coll Cardiol
(2004) - et al.
Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack
Am Heart J
(1995)
Identification of patent foramen ovale permitting paradoxic embolism
J Am Coll Cardiol
Positive contrast echocardiography in patients with patent foramen ovale and normal right heart hemodynamics
Am J Cardiol
Significance of left-sided heart disease for the detection of patent foramen ovale by transesophageal contrast echocardiography
J Am Coll Cardiol
Patent foramen ovaleanatomy versus pathophysiology–which determines stroke risk?
J Am Soc Echocardiog
Comparison of frequency of patent foramen ovale by transesophageal echocardiography in patients with cerebral ischemic events versus in subjects in the general population
Am J Cardiol
Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonographythe SPARC study
Mayo Clin Proc
Patent foramen ovale and the platypnea-orthodeoxia syndrome
Cardiol Clin
Femoral vein delivery of contrast medium enhances transthoracic echocardiographic detection of patent foramen ovale
J Am Coll Cardiol
Patent foramen ovaleparadoxical embolism and paradoxical data
Mayo Clin Proc
The use of ultrasonic reflectoscope for the continuous recording of the movements of the heart walls
Kungl Fysiografiska Sallskapets I Lund Forhandlingar
Ultrasound cardiographycontrast studies in anatomy and function
Radiology
Ultrasonic detection of cavitation at catheter tips
Am J Roentgenol
Contrast agents for diagnostic ultrasound
Invest Radiol
The source of ultrasound contrast effect
J Clin Ultrasound
Erythrocyte and polymorphonuclear cell transit time and concentration in human pulmonary capillaries
J Appl Physiol
Cited by (115)
Left Atrial Septal Pouch (LASP) and cryptogenic stroke risk: An updated systematic review and meta-analysis of observational studies
2024, Current Problems in CardiologyAtrial septal pouches and ridges: Morphological features and potential implications in clinical practice
2024, Trends in Cardiovascular MedicinePearls and Pitfalls in the Transesophageal Echocardiographic Diagnosis of Patent Foramen Ovale
2023, Journal of the American Society of EchocardiographyPercutaneous suture-based patent foramen ovale closure: A state-of-the-art review
2023, Trends in Cardiovascular MedicineIntraoperative and Early Postoperative Management of Patients Undergoing Minimally Invasive Left Ventricular Assist Device Implantation
2021, Journal of Cardiothoracic and Vascular AnesthesiaImportance of Abdominal Compression Valsalva Maneuver and Microbubble Grading in Contrast Transthoracic Echocardiography for Detecting Patent Foramen Ovale
2020, Journal of the American Society of Echocardiography