about 80 y old patient; condition after trans aortic valve implantation. the patient had a complicated and complex clinical history with plenty of diseases, these required a long elaboreted long stay
in ICU. In TEE and TTE we found a perforation of sinus valsalvae with flow towards the right atrium. (the video shows clips of TEE and TTE).
This four chamber apical TTE clip shows \bubbles\ or agitated saline being administered through a peripheral vein with the patient performing a valsalva maneuver. The result is immediate appearance of
bubbles in the left circulation consistent with interatrial shunting. The quality is not great, but you can see the single bubbles floating in the LV within 1-2 beats of the heart after injection of