Simultaneous massive pulmonary embolism and impending paradoxical embolism through a patent foramen ovale.

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 66-year-old obese woman presented with shortness of breath over 8 weeks. She was hemodynamically stable. D-dimer was elevated at 2.14. Transthoracic (Online Video [1][5]) followed by transesophageal