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Figure 5 Longitudinal transesophageal echocardiography (TEE) imaging in the midupper esophagus. A 32-year-old male presented with an embolic stroke. He was found to have occult thrombi in both calf veins. Transthoracic echocardiography with peripheral saline contrast during normal respiration and Valsalva were negative for a right-to-left shunt. (A) TEE revealed a small restrictive secundum atrial septal defect (ASD) (arrow). Note how this appearance is different from that of a patent foramen ovale. (B) Color Doppler demonstrates a left-to-right shunt with a color mosaic pattern from the shunt in the right atrium (RA). The ASD was subsequently surgically repaired. LA = left atrium; SVC = superior vena cava.