case_images: PMC8298126_01
case_images: Transesophageal echocardiography showing ventricular septal defect jet
  between the 12:00 and 2:00 positions (red arrow).
case_images: mdcvj-17-02-157-g1.jpg
case_images: PMC8298126_01_mdcvj-17-02-157-g1.jpg
case_images: F1
case_images: A VSD with predominant left-to-right shunting was observed on color Doppler TEE (Figures 1,2).
case_images: Severe biventricular dilation seen on cardiac magnetic resonance imaging.
case_images: mdcvj-17-02-157-g3.jpg
case_images: PMC8298126_01_mdcvj-17-02-157-g3.jpg
case_images: F3
case_images: CMR showed severe biventricular dilation and evidence of a supracristal VSD with an 8.5-mm defect adjacent to the right sinus of Valsalva (Figures 3,4).
case_images: Aorta-right ventricular outflow tract fistula demonstrated by the presence of
  systolic flow jet (red arrow).
case_images: mdcvj-17-02-157-g5.jpg
case_images: PMC8298126_01_mdcvj-17-02-157-g5.jpg
case_images: F5
case_images: The VSD was further complicated by development of an aorto-right ventricular outflow tract (RVOT) fistula with evidence of continuous left-to-right shunt across the VSD from the left side into the RVOT in the subpulmonic region (Figures 5,6).