Fig. 1. (A ) Atrial septal crossing of contrast medium during the Valsalva maneuver as detected by contrast-enhanced two-dimensional transesophageal echocardiography (c-TEE). RA = right atrium; LA = left atrium; AO = aorta; LV = left ventricle. (B ) Visual detection of high-intensity transient signals caused by the presence of contrast medium (cm-HITS; arrows) in the middle cerebral artery in contrast-enhanced transcranial Doppler ultrasonography (c-TCD).