Atrial septal defect contrast echocardiography

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Atrial Septal Defect Microchapters


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Ostium Secundum Atrial Septal Defect
Ostium Primum Atrial Septal Defect
Sinus Venosus Atrial Septal Defect
Coronary Sinus
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]


Echocardiography is the preferred diagnostic tool in the evaluation of an atrial septal defect. Contrast echocardiography is an effective modality that can be performed in individuals with a suspected atrial septal defect which is not visualized definitively on transthoracic imaging.

Contrast Echocardiography

  • Used to determine the presence of intercardiac shunting often seen in the apical four chamber view.
  • Agitated saline is commonly used as the contrast material.
  • Saline contrast can visualize heart function, problems in the left ventricle, and problems in the surrounding valves.
  • Injected into a peripheral vein during echocardiography, small air bubbles can be seen on the imaging.
  • It may be possible to see bubbles travel across an atrial septal defect either at rest or during a cough.
  • Bubbles will only flow from right atrium to left atrium if the RA pressure is greater than LA.

Common Findings

  • A right-to-left interatrial shunt can be seen:
  • When an atrial septal defect with accompanying pulmonary hypertension, resulting in a left-to-right reversal.
  • Any time a patent foramen ovale defect is present.
  • When an uncomplicated atrial septal defect has an imbalance in right-sided pressure, such as from coughing or the valsalva maneuver.
  • When an uncomplicated atrial septal defect has a momentary onset of left ventricular contraction.


  • Not recommended for:


  • False positives in the setting of a pulmonary arteriovenous malformation.
  • Difficulty in quantifying the size of the shunt.

2008 ACC / AHA Guidelines - Evaluation of the Unoperated Patient- Atrial Septal Defect (DO NOT EDIT)[1]

Class I
"1. ASD should be diagnosed by imaging techniques with demonstration of shunting across the defect and evidence of RV volume overload and any associated anomalies. (Level of Evidence: C) "


  1. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

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