Contrast transesophageal three-dimensional echocardiographic imaging for patent foramen ovale: A needful role?

The management of patent foramen ovale (PFO) still remains controversial. According to the newest scientific evidences, the assessment of the PFO size and the shunt has paramount importance for further management [1]. Although two-dimensional (2D) transesophageal (TE) echocardiography (E) contrast study has been considered to be the gold standard imaging modality for diagnosing PFO for a long time, new evidences underscore that its accuracy may have been over-valued [1,2]. Three-dimensional (3D) TEE imaging has emerged as a diagnostic technique that overcome some of the limitations of 2DE. 3D TEE allows an anatomical imaging for a comprehensive echocardiographic assessment of the left atrium, atrial septum and of PFO morphology [3,4]. However, it has never been reported about its diagnostic usefulness in detecting the bubbles passage during contrast study. We report a case where it has been possible to detect the passage of bubbles across the PFO thanks to 3D TEE.