Compelling argument for an agitated saline bubble study prior to cardiac transplantation

Cardiac transplant recipients with patent foramen ovale (PFO) are at risk for right-to-left shunting. Failure to identify this abnormality can have serious posttransplant consequences. In this article, we describe a cardiac transplant recipient with hypoxemia where a PFO was diagnosed postoperatively despite direct surgical investigation at the time of orthotopic heart transplantation (OHT). Transthoracic echocardiography with bubble study is relatively inexpensive, noninvasive, and simple and can be a useful method to identify PFO/atrial septal defect. Thus, authors recommend critically screening both donor and recipient hearts prior to OHT.