Subcostal view in a ventilated patient sustaining severe multisystem trauma and a circulatory failure: (A), (C) using hand-held echocardiography, and (B), (D) using a full-feature echocardiographic platform. Two-dimensional echocardiography in both cases revealed a large ventricular septal defect ((A) and (B), arrow). Color Doppler mapping confirmed the presence of a large left-to-right shunt ((C) and (D), arrow). The patient underwent immediate surgical repair, which confirmed the diagnosis. LV, left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium; Ao, ascending aorta.