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

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.