Agitated Saline Contrast Echocardiography in the diagnosis of right to left shunts: Guidance and recommendations from the British Society of Echocardiography

2026/05/31 by Bushra Rana, Shaun Robinson, Liam Ring +21 · 2 voices
Medicine · #Cardiovascular and Diving-Related Complications #Ultrasound in Clinical Applications #Vascular anomalies and interventions

paper · pdf · doi:10.1186/s44156-026-00117-3

openalex publication_date 2026/05/31 · openalex created_date 2026/06/01 · openalex updated_date 2026/07/29

Abstract

Contrast echocardiography encompasses two forms of ultrasound contrast agents. This article focuses on agitated saline (AS-C) contrast, commonly called 'bubble' contrast. Its main application is in identifying the presence of a right to left shunt in a number of clinical syndromes, often associated with a patent foramen ovale (PFO). Dependant on the clinical presentation, the presence of a PFO with a likelihood of a causal role may be considered for percutaneous PFO closure. This guideline outlines a structured approach to performing an AS-C transthoracic echocardiogram, including the indications, protocols, and potential pitfalls for performing AS-C transthoracic echocardiography (TTE). It also addresses when to proceed to more advanced imaging modalities and highlights clinical decision-making frameworks such as the RoPE score.

Discussions

• 🚨 NEW GUIDELINE 🚨 We're delighted to announce the publication of our new agitated saline contrast guideline - check it out here: https://doi.org/10.1186/s44156-026-00117-3 Read our blog: https://w [bsky, 1 points, 0 comments]
• 🚨NEW ARTICLE🚨 Agitated saline contrast echocardiography in the diagnosis of right to left shunts: Guidance and recommendations from the British Society of Echocardiography: https://doi.org/10.1186/ [bsky, 0 points, 0 comments]

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