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My understanding is that are 2 types of tests available: (1) transesophogeal (sp) (2) agitated saline administered through a vein in your arm. #1 is the most accurate and expensive and also has the most risk. #2 works well depending on the skill of your physician. Below is my experience in getting #2 done. What you ask for is a bubble study using a doppler echocardiogram $680. They will usually set you up for a normal echocardiogram and color flow as well which are not necessary, but take less than 30 seconds to set up and adds $90. Good for a healthy baseline I guess. Make sure you are specific in what you ask for and stress it is for detecting a PFO. Chances are the person taking the appointment has little clue to what you are after so keep on stressing what the purpose of the visit is. The procedure itself is very simple (assuming trained physician). A special syringe is used that agitates a saline solution which is then administered to the same vein that is commonly used for blood samples or donations (apologies for my weak medical terminology). The trick is really in how well the physician can get you to perform simple exercises that cause an increase in right side heart pressure (specifically in the right article). Each time the saline is added you will see an immediate color change in the right side of your heart. I was rather surprised at how quick blood flow really is - I mean it rips even with a low heart rate. During the course of coughing and other simple exercises there should be no migration of the bubbles to the left article. Any migration indicates a PFO, which I was fortunate not to have. For a good review on the physiology of this I would recommend the Jan 96 issue of DeepTech with an article written by George Irvine and Dr. David Doolette. Whether or not such a test is worthwhile or not I am not interested in debating. I find it hard to believe that all commercial dive schools and the Navy check it at their expense for just the sake of a laugh. If you have ever participated in a doppler study you know that you can detect bubbles in many fit people after a simple recreational dive. Whether its important to you to know whether you are recirculating them around your body through your brain is your decision. Regards, John
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