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FAQs: Contrast Echocardigram (Echo)
What is a Saline Contrast Echocardiogram?

The procedure will begin as any standard Echocardiogram (Echo). To learn more on the involvement of an Echo study click here.

The effective saline contrast study attempts to define a patent foramen ovale (PFO) when present. In the unborn child very little blood is needed to be pumped by the right ventricle to the lungs. Most of the blood can bypass this by flowing through the fossa ovalis, which creates communication between the left and right side of the heart. Shortly after birth the fossa ovalis is sealed, aided by changes of pressure within the heart. In approximately 15% of people the seal fails to occur, is incomplete or is forced open due to pathology. Blood may pass continuously through the PFO or in either direction during the cardiac cycle. Most concern exists when there is a right to left shunt which allows for possible passage of a clot trough the heart to the brain or other bodily extremities. A similar potential problem exists for divers who may have Nitrogen bubbles bypass the lungs and flow directly to the brain.

What should I expect?
How long will it take?
Where will it be done?

On completion of the standard Echo study a small needle will be placed in the upper left arm positioned near the elbow joint. After a small sting the needle tip is removed and a three-way tap to allow mixing is connected. A trivial amount of blood will be drawn back into the saline mix, which is standard and not to be concerned over. This is mixed to create microbubbles, which are injected on command. The microbubbles reflect ultrasound and create an opacification of the right side of the heart. In a negative study the bubbles are passed to the lungs, breathed out and not seen again. When a PFO is detected, the microbubbles will pass through to the left side of the heart. Specific exercises will be asked of you to change pressures and better define a PFO:

Valsalva A small breath in and the request to try and force air out with none escaping, as if blowing through a blocked straw.
Muller Similar to the above, now with a sucking motion.
Cough A small breath followed by a few light coughs.
Sniff A few sharp, short sniffs are all that is required.

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