PMC6635985_01
Still images from patient's transthoracic echocardiogram showing (
a) no early shunting with saline bubble (identified by yellow arrows) injection, followed by (
b) late passage of bubbles (identified by red arrows) into the Left Atrium and Ventricle representing Intrapulmonary Shunting.
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A transthoracic echocardiogram with bubble study was then performed which suggested an intrapulmonary shunt (see Figure 1), thereby confirming the diagnosis of HPS.