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case_images: Intracranial artery CTA images showing no pathological change. (A) Anterior view of intracranial arteries. (B) Left side view of intracranial arteries.
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case_images: An intracranial artery CTA examination was conducted at our hospital, revealing no stenosis, infarction, or subarachnoid hemorrhage (Figure 1A,B).
case_images: Right heart contrast echocardiography examination showing that a large number of cloudy microbubbles (> 30 per frame) were detected in the left ventricle (red oval circle).
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case_images: The contrast right heart echocardiography demonstrated a significant presence of microbubbles in the left atrium and ventricle during the first cardiac cycle following an effective Valsalva maneuver (Figure 2).
case_images: Transthoracic echocardiography. (A) A tubular structure between the beginning of the left pulmonary artery and the descending aorta (red arrow). (B) A beam of blood flows through the arterial catheter (red arrow). (C) The widened coronary sinus (red arrow). (D) The persistent left superior vena cava (red arrow).
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case_images: Another abnormal finding on echocardiography was a persistent left superior vena cava connecting to the enlarged coronary sinus (Figure 3A-D).
case_images: Transesophageal echocardiography. (A) A 1.3-mm oblique separation at the oval fossa after Valsalva's maneuver (red arrow). (B) After Valsalva's maneuver, a slight left to right shunt was observed at the foramen ovale of the atrial septum (red arrow).
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case_images: Small-volume shunt flow from the left atrium to the right atrium was also observed (Figure 4A,B).