Altered hemodynamics due to multiple anomalies. Cine and velocity flow images show two turbulent jets, consistent with significant right-to-left shunting: 1) an antegrade flow from the dilated pulmonary artery through the ductus (arrow) towards the descending aorta, and 2) a retrograde flow towards the left subclavian artery, predominantly during systole. MPA: main pulmonary artery; Asc Ao: ascending aorta; Des Ao: descending aorta. 