Transesophageal echocardiography: clinical indications and applications.

Case: A 36 year-old woman without significant past medical history was admitted with left-sided hemiparesis. Imaging studies confirmed a right middle cerebral artery (MCA) stroke with normal carotid arteries. Transesophageal echocardiogram (TEE) showed right heart enlargement and a large secundum atrial septal defect (ASD) (Figure 1). Using TEE guidance, an ASD occluder device was placed without complication (Figure 2).