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

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.

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Publication Details

Journal
Echo Research and Practice
Published
2026-05-31
DOI
https://doi.org/10.1186/s44156-026-00117-3
Primary Topic
Cardiovascular and Diving-Related Complications
Type
article
Field-Weighted Citation Impact
0.00
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article

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

Neil Ruparelia, Jim Newton, Nina Bual, Iqbal Malik et al.
Echo Research and Practice
Cardiovascular and Diving-Related Complications
article

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

Neil Ruparelia, Jim Newton, Nina Bual, Iqbal Malik, Shaun Robinson, Alfa Ali, Bushra Rana, Mark Spence, Nilesh Sutaria, Anjana Siva, Brian Clapp, Mark Turner, Martin Swaans, Dave Oxborough, Michael Mullen, David Northridge, Chris Baker, Victoria Delgado, Mark Belham, Horst Sievert, Nina Wunderlich, Roxy Senior, Dave Hildick-Smith, Liam Ring
article en

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.

Echo Research and PracticeVol. 13(1)
St Bartholomew's Hospital (GB), St Thomas' Hospital (GB), Imperial College Healthcare NHS Trust (GB), Guy's and St Thomas' NHS Foundation Trust (GB), West Suffolk NHS Foundation Trust (GB), Royal Sussex County Hospital (GB), University Hospitals Bristol NHS Foundation Trust (GB), Cambridge University Hospitals NHS Foundation Trust (GB), John Radcliffe Hospital (GB), Edinburgh Royal Infirmary (GB), Queen Alexandra Hospital (GB), Royal Brompton Hospital (GB), St. Antonius Ziekenhuis (NL), West Suffolk Hospital (GB), Cardiovascular Center Frankfurt (DE), Mater Private Hospital (AU), Asklepios Klinik Langen (DE), Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (ES), Hospital Universitari Germans Trias i Pujol (ES), Addenbrooke's Hospital (GB), Liverpool John Moores University (GB)
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Openalex Percentile: Top 6%
Cardiovascular and Diving-Related Complications
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