The British Society of Echocardiography (BSE) is delighted to announce the publication of a new guideline on agitated saline contrast echocardiography in the diagnosis of right to left shunts.
The guideline outlines a structured approach to performing an agitated saline (bubble) transthoracic echocardiogram. The guidance includes the indications, protocols, and potential pitfalls. It also addresses when to proceed to more advanced imaging modalities and highlights clinical decision-making frameworks such as the RoPE score. Detailed advanced imaging including transoesophageal echocardiography (TOE) in the assessment for percutaneous patient foramen ovale closure pre and post closure is not included and will be discussed in future publications as required.
This guidance provides a standardised protocol, as well as a structured reporting template, reducing variability in practice and leading to greater consistency. It will support a standardised method for triaging and appropriately proceeding to an agitated saline study, as well as provide referrers for this advanced imaging study with clear guidance of when to refer and seek advice in the appropriate patient cohorts.
This guidance is the first of its kind and has involved signification collaboration with European leaders in echocardiography. It is hoped that it will provide guidance not only to the UK but to the global echo community.
This guideline will be published in the BSE’s official journal, Echo Research and Practice. Dr Bushra Rana, Consultant Cardiologist at Guy’s and St Thomas’ Hospitals NHS Trust and lead author said, “Guidance on this essential topic is long overdue and we hope that it will provide a standardised and structured approach to performing a bubble TTE to support BSE members.”
Dr Kelly Victor, Co-Chair of Education said, “This guideline offers a very practical approach in how to perform a bubble study. By embracing this guidance, we can ensure greater consistency in clinical practice within the UK and beyond.”
Read the guideline