Correct!
1. Repeat echocardiogram with a bubble study

Most causes of ventilation-perfusion mismatch have been excluded or are very unlikely. A right-to-left shunt is one pathophysiologic mechanism that needs to be excluded and a repeat echocardiogram with a bubble study is appropriate. The study showed bubbles on the left side of the heart after only 2 cardiac cycles indicative of a right-to-left shunt.

Which of the following is appropriate therapy at this time?

1. Inhaled nitric oxide to lower pulmonary artery pressure
2. Surgical correction of a patent foramen ovale
3. Surgical correction of a patent ductus arteriosus
4. Percutaneous closure of a patent foramen ovale
5. Surgical correction of Ebstein’s anomaly

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