Echocardiogram with Bubble Btudy

Tiny air bubbles are all around us, floating in water, air, or even in our drinks. These microscopic bubbles even help doctors examine the inside of our heart. A bubble study echocardiogram is a specialized type of ultrasound that utilizes agitated saline bubbles to diagnose abnormal connections in the heart chamber. It is also called the bubble contrast echocardiogram.

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In this article, we will explore what a bubble study echo is, its uses, how we prepare for it, and what the results mean for our health.

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What is a bubble study echocardiogram?

Ultrasound of the heart is called an echocardiogram. It uses sound waves that the human ear cannot hear. The test provides information about the structure and function of the heart's muscles, chambers, and valves.

A bubble contrast echocardiogram utilizes ultrasound technology combined with the injection of microbubbles to provide additional information.

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Procedure for a bubble echocardiogram:-

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Preparing for the procedure

• Continue with all your medications as usual
• The test does not require fasting
• Take plenty of fluids before the test, as it helps in blood flow.

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During the procedure

• A trained sonographer performs a bubble echocardiogram
• ECG electrodes are placed on the chest and connected to wires to monitor heart rate and rhythm during the scan.
• A cannula is inserted into the vein of the hand.
• A small amount of sterile saline is agitated, forming microscopic bubbles which are then injected into the vein.
• The protein in the blood holds the bubbles in the mixture
• You are then asked to lie down on the left side with your left arm above your head
• Ultrasound gel is applied to the centre of the chest, and the transducer is moved into different positions below the left breast and rib cage
• As the bubbles are injected, they flow through the bloodstream into the heart, and an echocardiogram can be used to take pictures.
• Some images are taken as the bubble contrast is being injected, and you may be asked to breathe in a particular way.
• One can hear the sounds coming from the echo machine during the scan; it is the sound of blood moving through the heart.
• The entire procedure takes around 30 to 45 minutes.

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Recovery from the procedure

Once the test is finished, no recovery time is required, and you can drive back home.

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Types of echocardiography used with bubble studies:-

Bubble studies in echocardiography utilize transthoracic (TTE) and transesophageal echocardiography (TEE). They help us to visualize how the bubbles pass through the heart.

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Transthoracic echocardiography

It is the most common type of echo that is used in bubble studies

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A transducer is placed on the chest and moved, which helps visualize the heart structures and function, as well as the passage of microbubbles injected into a vein.

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Transesophageal echocardiography

A transducer in TEE is inserted into the esophagus. This method provides clear images of the heart atria and atrial septum as the esophagus lies near the heart.

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Reasons for doing a bubble study echocardiogram:-

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Detecting holes (shunts) in the heart.

They help to identify PFOs and ASDs.

Shunts are abnormal connections that allow blood to flow between different chambers or vessels in the heart. They bypass the normal circulatory pathway.

Shunts can be left-to-right when oxygenated blood flows to the lungs. They’re right-to-left when deoxygenated blood enters the circulation.

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Investigating stroke

Blood or emboli bypass the lungs through holes in the heart and reach the brain, causing a stroke. Bubble studies help to investigate stroke when there is no apparent cause.

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They help to screen for pulmonary atrioventricular (AV) malformations, which are extra communications (small holes) between blood vessels in the lungs.

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They help in guiding procedures of the heart, such as catheter placement and fluid drainage.  

Risk of a bubble echocardiogram

The bubble test is safe. The bubbles injected are small and are usually filtered out by the lungs, so they do not cause any harm.

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Injecting large quantities of air into a vein can be harmful, but when bubbles are injected in small quantities, there is no bulge in the interatrial septum, and the lungs filter out these bubbles.

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If you have a Patent Foramen Ovale (PFO), some bubbles will appear on the left side of the heart and then gradually make their way through the circulation, being filtered out through the lungs. Very rarely do they cause migraines or headaches.

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What do the results mean?

If the heart is normal, the bubbles will be seen only on the right side.

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Bubbles appearing on the left side of the heart indicate that a valve is still open, and it may indicate atrioseptal defect (ASD) or patent foramen ovale (PFO).

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They also indicate the severity of PFO depending on the number of bubbles.

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Conclusion

A hole in the heart does not show up on a standard echocardiogram, and it is for this reason that cardiologists use bubble contrast echocardiography. It uses imaging ultrasound and injection of saline with tiny, microscopic bubbles to detect it. Bubbles appear on the left side of the heart, indicating the valve is open due to the presence of a hole.