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Updated: Jul 17, 2025

Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Overcoming a stubborn patent foramen ovale
John Gallagher1, John Dawdy2, Luis Afonso2
1Wayne State University School of Medicine, Detroit, Michigan, USA.
Abstract:
Transesophageal echocardiography (TEE) with agitated saline contrast ("bubble study") is the gold standard for detection of patent foramen ovale (PFO). Standard provocative maneuvers help facilitate right-to-left shunting necessary for diagnosing PFO but may be difficult to implement during TEE. Hypovolemia related to preprocedural fasting may challenge detection of PFO in TEE, and additional optimization measures such as fluid replenishment with passive leg raise (PLR) can enhance PFO detection. We present a 57-year-old male with history of cryptogenic stroke and stubborn PFO which during TEE bubble study responded only to ample fluid replenishment with PLR following a period of prolonged preprocedural fasting.
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