Interatrial Septal Left-to-Right Shunt

This subcostal 4-chamber view from transthoracic echocardiography zoomed in to the interatrial septum shows left-to-right flow (red-orange jet) through an atrial septal defect (ASD) in a 65-year-old man with recurrent strokes attributed to inadvertent traversal of a pacemaker lead through the ASD into the left ventricle (LV). Click the related article link for an additional transthoracic echocardiography video demonstrating the unintended LV lead placement and for full case details.