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

Rana, B, Robinson, S, Ring, L, Oxborough, D ORCID: 0000-0002-1334-3286, Belham, M, Newton, J, Ali, A, Sutaria, N, Bual, N, Swaans, M, Wunderlich, N, Delgado, V, Northridge, D, Hildick-Smith, D, Ruparelia, N, Turner, M, Mullen, M, Baker, C, Clapp, B, Spence, M et al (2026) Agitated Saline Contrast Echocardiography in the diagnosis of right to left shunts: Guidance and recommendations from the British Society of Echocardiography. Echo Research and Practice, 13 (1). ISSN 2055-0464

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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.

Item Type:	Article
Uncontrolled Keywords:	Bubble contrast; Agitated saline; Transthoracic echocardiogram; Patent foramen ovale; Agitated saline; Bubble contrast; Patent foramen ovale; Transthoracic echocardiogram
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	BMC Springer Nature
Date of acceptance:	7 April 2026
Date of first compliant Open Access:	11 June 2026
Date Deposited:	11 Jun 2026 12:41
Last Modified:	11 Jun 2026 12:41
DOI or ID number:	10.1186/s44156-026-00117-3
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28810

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