Hypoxemia without persistent right-to-left pressure gradient across a patent foramen ovale: A clinical challenge

Figure 1 Transesophageal echocardiography with bubble study. A: Transesophageal echocardiography (TEE) of the patient with a patent foramen ovale (PFO) showing a wide separation in the inter-atrial septum; B: TEE with injected agitated saline showing the presence of bubbles in the right atrium; C: TEE of the patient within the same cardiac cycle showing jet of bubbles crossing the inter-atrial septum through the PFO; D: Opacification of entire left atrium as the jet of bubbles gushes through the PFO.

Figure 2 Transthoracic echocardiography with Doppler showing significant flow of blood across the inter-atrial septum.