Bubble echocardiography

What is meant by Bubble echocardiography?

One of the best ways to identify the presence of a hole in the heart, such as Atrial Septal Defect (ASD) or a Patent Foramen Ovale (PFO) is to perform a bubble study.

An Echo Bubble Study is an injection of saline after agitation with air to create micro-bubbles that are ultrasound reflective into a vein in order to reach and opacify the right heart chambers, the coronary sinus in cases of persistent left superior vena cava (PLSVC), or the pericardium during pericardiocentesis.

Normally, the right (low pressure side of the heart) does not communicate with the left high pressure side of the heart. However, in individuals with an ASD or PFO blood can flow from right to left.

What happens during an Echocardiogram?

A normal transthoracic Echocardiogram is performed. A small needle will be placed into the vein on the back of the hand. Some sterile saline will then be drawn up into a syringe and agitated so that microscopic bubbles are formed in the saline solution. These are then injected briskly into the vein, whilst the imaging takes place. The right side of the heart (connected to the venous system) opacifies very nicely, as the bubbles show very brightly on the Echocardiogram. You may be asked to strain to encourage bubbles to go across.