High velocity jet from Gerbode type defect mixed with tricuspid regurgitation jet. RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium;TV, tricuspid valve; Veg, vegetation. A) Continuous wave Doppler from Gerbode type defect mixed with tricuspid regurgitation jet revealing a high velocity jet simulating severe pulmonary arterial hypertension with estimated systolic pulmonary arterial pressure of 83 mmHg. B) Transeosophageal echocardiography four-chamber view demonstrating a large vegetation in RA located just above the tricuspid valve septal leaflet. Its attachment was not precisely defined, but no obstruction was identified at the level of tricuspid valve. C) The color Doppler demonstrating a systolic flow between the LV and both RV and RA.