Goal-directed vs self-directed Valsalva manoeuvre to improve right to left shunt detection: the BUBBLE trial

Key result

Goal-directed Valsalva compares with self-directed approaches for detecting right-to-left shunts.

Key Points

To compare the diagnostic efficacy of a goal-directed Valsalva manoeuvre against a self-directed manoeuvre in identifying right-to-left intracardiac shunts during bubble contrast echocardiography.
Conducted the BUBBLE clinical trial evaluating patients undergoing contrast echocardiography for right-to-left shunt detection.
Assigned participants to perform either a goal-directed Valsalva manoeuvre using targeted strain pressure or a conventional self-directed manoeuvre.
Goal-directed strain achieved superior standardization of intrathoracic pressure compared to self-directed efforts.
The structured maneuver improved the detection rate and visualization of right-to-left shunt microbubbles relative to unguided self-direction.

Reveals improved right-to-left shunt detection with goal-directed Valsalva manoeuvre, indicating enhanced diagnostic sensitivity for cardiac defects.

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Grinberg et al. (2026) studied this question.

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