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Figure 2 Selected video frames from transesophageal echocardiographic studies performed during an over-the-wire implantation of a fourth generation buttoned device. a) Atrial septal defect (ASD) is shown (arrow). b) and c) The occluder (Occ) component of the device at various positions in the left atrium (LA) and the Amplatz wire (AW) passing through the ASD and Occ is seen. d) The Occ on the left atrial side with a tiny residual shunt (TRS) is shown (arrow).