Six weeks ago, I underwent a transcranial Doppler with microbubbles. There was no shunting at rest, but major right to left shunting during the Valsalva maneuver. The cardiologist was confident that I had a Patent Foramen Ovale. This morning I underwent a transesophageal echocardiogram. No PFO was found! The doctor was amazed. He will be sending me for more tests to find the "leak" but I have been disqualified from the medical study I was participating in. Any ideas where the shunting could be coming from? I thought I had a PFO and had nothing to worry about. Should I be worried now?
A PFO is only one of the many possible connections between the Right and left systems. You could have an AV fistula, or a pulmonary vein that empties to the right atrium. Hence a CT angiogram of the chest should give than answer in most patients, for why you are having microbubbles on a TCD during valsalve.
Another possibility is that you did not strain hard enough during the TEE because of sedation, so the shunting was never observed during that procedure. .
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