Agitated Saline Contrast Echocardiography in the diagnosis of right to left shunts: Guidance and recommendations from the British Society of Echocardiography
Year: 2026
Type: article
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.
Source: Echo Research and Practice
Authors: Bushra Rana, Shaun Robinson, Liam Ring, Dave Oxborough, Mark Belham, Jim Newton, Alfa Ali, Nilesh Sutaria, Nina Bual, Martin Swaans, Nina Wunderlich, Victoria Delgado, David Northridge, Dave Hildick-Smith, Neil Ruparelia, Mark Turner, Michael Mullen, Chris Baker, Brian Clapp, Mark Spence, Horst Sievert, Iqbal Malik, Roxy Senior, Anjana Siva
Institutions: St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Imperial College Healthcare NHS Trust, West Suffolk NHS Foundation Trust, West Suffolk Hospital, Liverpool John Moores University, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, John Radcliffe Hospital, St. Antonius Ziekenhuis, Asklepios Klinik Langen, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Edinburgh Royal Infirmary, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, University Hospitals Bristol NHS Foundation Trust, St Bartholomew's Hospital, Royal College of Surgeons in Ireland, Cardiovascular Center Frankfurt, Royal Brompton Hospital, Queen Alexandra Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,390
OpenAlex ID: W7162953643