Right-to-left shunt detection via synchronized contrast transcranial Doppler combined with contrast transthoracic echocardiography: A preliminary study

Figure 5 Contrast transthoracic echocardiography. A: Contrast transthoracic echocardiography showing a small right-to-left shunt (RLS) at rest and during the Valsalva maneuver (VM); B: Contrast transcranial Doppler identifies a small RLS at rest and a large RLS during VM; C and D: Enhanced transesophageal ultrasonography revealing a patent foramen ovale (arrow) with a large presence of microbubbles (arrow).