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Right-to-left shunt depending on the support level of Impel..:

Sato, Satoru ; Hiraoka, Arudo ; Toki, Misako..
European Heart Journal - Cardiovascular Imaging.  23 (2022)  8 - p. e296-e296 , 2022
Link: https://doi.org/10.1093/ehjci/jeac084