Usefulness of Intravenously Administered Fluid Replenishment for Detection of Patent Foramen Ovale by Transesophageal Echocardiography

Accuracy of Imaging Modalities in Detection of Baffle Leaks in Patients Following Atrial Switch Operation

“…Agitated saline studies negate this issue by being able to essentially evaluate the entire baffle for leaks. Multiple adult studies have shown that the use of agitated saline with or without Valsalva maneuver can increase effectiveness of identifying a PFO; thus, this finding is verification of previous studies . Realistically, patients presenting for TTE do not have intravenous access; however, patients undergoing TEE will likely have some form of intravenous access.…”

“…TEE has been demonstrated to be the gold standard for the detection of a patent foramen ovale (PFO) in the adult population . It is also suggested in multiple studies that the use of agitated saline with or without Valsalva maneuver can increase effectiveness of identifying a PFO by TEE …”

Cardiac Platypnea‐Orthodeoxia Syndrome: An Often Unrecognized Malady

“…The test is considered positive for shunt if any bubbles appear within the left atrium, and suggests an intracardiac shunt if those bubbles appear within 3 cardiac cycles . Intravenous fluid replacement or performance of the Valsalva maneuver can significantly increase the sensitivity of the bubble study, and should be considered if no shunt is detected despite a strong clinical suspicion . Other modalities for assessing intracardiac defects include right‐heart catheterization, ventilation‐perfusion scan demonstrating early extrapulmonary uptake, and transcranial Doppler; however, these tests should typically be employed only in the setting of an inconclusive echocardiographic study.…”

“…14 Intravenous fluid replacement or performance of the Valsalva maneuver can significantly increase the sensitivity of the bubble study, and should be considered if no shunt is detected despite a strong clinical suspicion. 5,15 Other modalities for assessing intracardiac defects include right-heart catheterization, ventilation-perfusion scan demonstrating early extrapulmonary uptake, 16 and transcranial Doppler 4 ; however, these tests should typically be employed only in the setting of an inconclusive echocardiographic study. Cardiac magnetic resonance imaging can also be used to search for distortions in normal cardiac anatomy, which may explain the right-to-left shunting.…”

Provocative maneuvers to improve patent foramen ovale detection: A brief review of the literature

“…Preprocedural fasting before TEE may cause hypovolemia and decrease right atrial pressure, undermining shunt detection. An interesting study from 2010 inspects this very question . A total of 103 patients (after exclusion of patients with known heart failure or critically ill) were included in this study.…”