Figure 9: (a) Transesophageal echocardiogram of the patient #6 showing a large superiorly located atrial septal defect. Significant echo contrast is seen in the right atrium [*].(b) Color doppler showing bi-directional flow across the atrial septal defect.(c) Balloon occlusion with an equalizer balloon (arrow) was done under transesophageal echocardiographic guidance which confirmed the appropriate position of the balloon as well as complete occlusion.(d) Post-balloon occlusion, the left ventricular end diastolic pressure increased to 26 mmHg