Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions

Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

“…ICE imaging quality has been shown to be comparable to TEE and allows for a better visualization of the septal rims before closure 13, 64. ICE also obviates the need for general anesthesia.…”

“…Evaluation of patients with suspected PFO should start with a transthoracic echocardiogram (TTE) and administration of agitated saline bubbles 13. The “bubble study” is best done in the standard apical 4‐chamber view.…”

“…Color Doppler should also be used to evaluate the presence of flow across the PFO, but this method is less sensitive for detecting small PFOs (Figure 3). 13 …”

“…TTE remains the preferred initial diagnostic modality for detection of PFO; however, a transesophageal echocardiogram (TEE) or intracardiac echocardiography (ICE) is sometimes required to identify or further characterize the PFO and interatrial septum (IAS) 13. TEE can clearly identify the anatomical detail of the PFO, including tunnel length, margins or rims, and surrounding structures (aorta, superior and inferior vena cava, pulmonary veins, and coronary sinus) 13…”

“…Another method for detecting shunting from a PFO is transcranial Doppler (TCD) ultrasonography 13, 14. This method uses spectral Doppler frequency.…”