Figure 2.

Transthoracic echocardiography demonstrates marked right ventricular dilatation (A), color Doppler M-mode in the parasternal long-axis view shows turbulent flow across the interventricular septum during the systolic phase compatible with ventricular septal defect patch leakage (B). Transesophageal echocardiography shows severe degenerative calcification with limited opening of the pulmonary valve (C) compatible with severe pulmonary stenosis (right ventricle-to-pulmonary artery conduit dysfunction) indicated by the yellow arrow.