Tests and diagnosis

By Mayo Clinic Staff

A doctor trained in heart conditions (cardiologist) may order one of the following tests to diagnose a patent foramen ovale:


An echocardiogram shows the anatomy, structure and function of your heart. The standard form of this test is called a transthoracic echocardiogram.

With this test, a technician spreads gel on your chest and then presses a device called a transducer against the skin over the heart. The transducer emits high-pitched sound waves and records the sound wave echoes as they reflect off internal structures in the heart. A computer converts the echoes into moving images on a monitor. Variations of this procedure may be used to identify patent foramen ovale, including:

  • Color flow Doppler. When sound waves bounce off blood cells moving through your heart, they change pitch. These characteristic changes (Doppler signals) and computerized colorization of these signals can help your doctor examine the speed and direction of blood flow in your heart.

    If you have a patent foramen ovale, a color flow Doppler echocardiogram could detect the flow of blood between the right atrium and left atrium.

  • Saline contrast study (bubble study). With this approach, a sterile salt solution is shaken until tiny bubbles form and then is injected into a vein. The bubbles travel to the right side of your heart and appear on the echocardiogram.

    If there's no hole between the left atrium and right atrium, the bubbles will simply be filtered out in the lungs. If you have a patent foramen ovale, some bubbles will appear on the left side of the heart. This is harder to detect with transthoracic imaging in general.

Transesophageal echocardiogram

This test uses a small transducer attached to a tube inserted down the esophagus — the part of the digestive tract that runs from the throat to the stomach. Because the esophagus lies close to the heart, having the transducer placed there provides a detailed image of the heart and blood flow through the heart.

The use of a transesophageal echocardiogram makes it easier to see a patent foramen ovale by either a color flow Doppler or a saline contrast study.

Other tests

Your doctor may recommend additional tests if you're diagnosed with a patent foramen ovale and you have had a stroke. Your doctor may also refer you to a doctor trained in brain and nervous system conditions (neurologist).

July 16, 2015