Intraoperative transoesophageal echocardiography and follow-up transthoracic echocardiography during patent foramen ovale and pulmonary arteriovenous malformation closure. (A) Intraoperative transoesophageal echocardiography: grade 3 bubble flow from the right upper pulmonary vein to the left atrium. (B) Intraoperative transoesophageal echocardiography: post-patent foramen ovale closure with occlusion device. (C) Transthoracic echocardiography post-patent foramen ovale closure, pre-pulmonary arteriovenous malformation closure: grade 4 left heart opacification >4 cycles after right heart. (D) Transthoracic echocardiography 4 months post-pulmonary arteriovenous malformation closure: no left heart bubble flow.