Objective: To analyze the diagnostic value of transthoracic right heart contrast echocardiography (c-TTE) combined with transcranial color-coded Doppler (c-TCCD) in patent foramen ovale (PFO). Methods: A total of 180 suspected PFO patients admitted from October 2023 to October 2025 were selected and evenly divided using a random number table. The observation group underwent c-TTE combined with c-TCCD for diagnosis, while the reference group underwent c-TTE alone. The diagnostic effects of the two groups were compared. Results: The detection rates of PFO in the observation group under both resting state and Valsalva maneuver were higher than those in the reference group (p < 0.05). Apart from the aperture size and thickness of the secondary septum, there were differences in other anatomical indicators between the two groups (p < 0.05). The detection rate of grade III shunt in the observation group was higher than that in the reference group (p < 0.05). Using the diagnostic results of transesophageal echocardiography (TEE) as the gold standard, the sensitivity and accuracy of the observation group were higher than those of the reference group, while the missed diagnosis rate was lower than that of the reference group (p < 0.05). Conclusion: The diagnosis of c-TTE combined with c-TCCD can effectively detect PFO, fully assess changes in the cardiac anatomical structure of patients, and determine shunt conditions, demonstrating high diagnostic efficacy.