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Figure 3 Adverse procedural events detected by intracardiac echocardiography. (A and B) Malpositioned Cardioseal and Amplatzer devices with both discs on right atrial (RA) side of aorta (Ao). (C) Color flow demonstrates a residual leak in this patient, with two devices already deployed. Intracardiac echocardiography demonstrated this to be a small additional fenestration. (D) This second large inferior defect was not identified by transesophageal echocardiography. Note the sizing balloon inflated within a more superior defect and the coronary sinus (CS) and mitral valve (MV).