Left: A small ventricular septal defect is present in the paramembranous portion of the interventricular septum (*), allowing blood to shunt from the left ventricular outflow tract to the right ventricle just below the tricuspid valve. Right: Color-flow Doppler shows turbulence associated with the left-to-right shunt. Right long-axis view, RV = right ventricle, LV = left ventricle.