Positive contrast echocardiography in patients with patent foramen ovale and normal right heart hemodynamics.

Peripheral M mode contrast echocardiograms were performed at rest and during the Valsalva maneuver in 11 patients with patent foramen ovale and normal right heart pressures documented by catheterization studies. Positive contrast studies (at least five clearly identifiable contrast echoes appearing in the left heart) were obtained in three patients (27 percent at rest) in six (54 percent) during the Valsalva maneuver and in seven patients (64 percent) either at rest or during the Valsalva maneuver. It is concluded that contrast echocardiography offers an opportunity to diagnose a patent foramen ovale noninvasively in patients with suspected paradoxical embolism or with questionable evidence of atrial septal defect. A positive study result does not specifically indicate heart disease since it occurs in healthy persons with patent foramen ovale, normal intracardiac pressures and no other abnormality.