Off-axis apical view with contrast injection (agitated saline). Patient has dextrocardia (A). Note good opacification of the right atrium and right ventricle in (B) with contrast. No contrast is seen initially in the left atrium, suggesting no atrial level shunt. Bubbles were seen in the left atrium after several beats (C) suggesting intrapulmonary shunts or arteriovenous malformations rather than intracardiac shunts (images courtesy of Jimmy C Lu MD). Abbreviations: LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.