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Protocol for Optimal Detection and Exclusion of a Patent Foramen Ovale Using Transthoracic Echocardiography with Agitated Saline Microbubbles


Address for correspondence and reprint requests: Vincent L. Sorrell, M.D., F.A.C.C., F.A.S.E., Clinical Medicine and Radiology Charles C. Hudson and Helen Lovaas Endowed Chair of Cardiac Imaging Sarver Heart Center, University of Arizona, 1501 N Campbell Avenue Tucson, AZ 85724. Fax: 520-626-4333; E-mail:


Agitated saline bubble studies in conjunction with echocardiography, in particular transesophageal echocardiography, are currently the principal means in the diagnosis of patent foramen ovale (PFO). We describe techniques and guidelines for the detection and exclusion of a PFO. The potential for misinterpretation of these bubble studies exists and therefore, several false positive and false negative scenarios are illustrated and discussed.