Direct injections are required to demonstrate these satisfactorily as visualisation of negative contrast effects from the shunt with a non-selective study is unlikely.

Ventricular septal defect

· This ideally requires a direct left ventricular injection.
· Simultaneous filling of the left and right ventricles is seen.
· A jet of contrast agent may be seen across the VSD.

Patent ductus arteriosus

This requires injection into the ascending aorta ( Fig. 2.6 ). Dilation of the aorta or pulmonary artery may be seen.

Sometimes a non-selective injection will visualise the PDA.

Atrial septal defect

While directing a catheter into the heart it may go through the ASD, from which an injection into the left atrium will reveal the defect. Alternatively a right-sided catheterisation into the pulmonary artery will demonstrate an ASD.

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