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  1. Jesus G Mirelis1,2,
  2. Esther Gonzalez Lopez1,
  3. Miguel A Cavero1,
  4. Luis Alonso-Pulpon1
  1. 1Cardiology Department, Puerta de Hierro Majadahonda Univesitary Hospital, Majadahonda, Madrid, Spain
  2. 2Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
  1. Correspondence to Dr Jesus G Mirelis, Puerta de Hierro Majadahonda Universitary Hospital, Manuel de Falla, 1, Majadahonda, Madrid 28222, Spain; jesus.gmirelis{at}

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A 48-year-old asymptomatic male, presented with mild elevation of transaminases and incidentally a basal oxygen saturation of 91% was registered. To rule out right to left shunting, the patient underwent a transoesophageal echocardiography. Initially, an intravenous cannula positioned on the left arm was used to inject agitated saline contrast. Unexpected opacification of the left atrium was observed (figure 1, online supplementary …

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