Bubble Study — Report Helper

BSE agitated saline contrast (AS-C) TTE structured report · Rana et al. Echo Res Pract 2026

Baseline IAS characteristics

Atrial septum mobility

Septum secundum

Colour flow across IAS

Eustachian valve / Chiari

BSE: document IAS mobility (± ≥10 mm sway), thick septum secundum (≥10 mm), colour flow direction/timing, and Eustachian valve/Chiari network.

Procedure details

Scanner

Injector

Consent

IV access side

IV site

Contrast preparation

Injections at rest

Injections with Valsalva

Injections with sniff/cough

Right heart opacification

BSE protocol: rest then Valsalva (± sniff/cough if negative or not large). Aim for complete RA opacification along the IAS.

Study result & timing

Overall result

Contrast appearance timing

Cycles to LH appearance (optional)

Count from dense RH opacification.

Shunt level impression

Phasic LA entry (PFO pattern) Gradual build then decay (PAVM/HPS pattern) Bubbles seen entering via pulmonary vein Bubbles visualised crossing IAS

Shunt grade (BSE 1–4, single still frame)

Grade at rest

Grade with Valsalva

Grade with sniff/cough

Complications

Optional free-text note

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BSE shunt grading reference (Table 8)

Grade	Subjective	Objective (one still frame)
1	A few scattered bubbles in LA or LV	≤5 bubbles
2	Clusters of bubbles in LA or LV	5–25 bubbles
3	Clouds of bubbles without complete opacification	>25 bubbles, still countable
4	Complete LH chamber opacification	Confluent; typically >50 bubbles

Early LH appearance (typically within 3 cycles of RH opacification, or after Valsalva release) favours intracardiac shunt. Late appearance with gradual build-then-decay favours intrapulmonary shunt (e.g. PAVM / HPS). Grade on any single still frame. Source: Rana B et al. Agitated Saline Contrast Echocardiography… BSE. Echo Res Pract. 2026;13:16.