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. 2021 Oct 1;14(10):e245301. doi: 10.1136/bcr-2021-245301

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Transoesophageal echocardiography (TOE) excluding right-to-left interatrial shunt. TOE demonstrating right-to-left interatrial shunt in a patient receiving high-flow nasal oxygen. (A) Labelled 2D mid-oesophageal bicaval TOE view of the heart. (B) Labelled 2D mid-oesophageal bicaval TOE view of the heart after intravenous injection of saline microbubble contrast demonstrating grade 2 shunt (5–25 bubbles in LA). Bubbles appeared in the LA within three cardiac cycles of opacification of the RA demonstrating the presence of a right-to left interatrial shunt. LA, left atrium; RA, right atrium.