{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:14Z","timestamp":1753876274083,"version":"3.41.2"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background\u2003<\/jats:title>\n                  <jats:p>Bioprosthetic tricuspid valve stenosis (TS) is an uncommon and frequently under-diagnosed condition. Although the resulting right heart failure symptoms are well-known, the associated thrombogenic potential is under-recognized.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary\u2003<\/jats:title>\n                  <jats:p>A 44-year-old woman with bioprosthetic tricuspid valve (TV) replacement in 2001 was referred for urgent consultation due to acute worsening of dyspnoea and severe swelling and pain in her left arm and neck. She was diagnosed with atrial fibrillation 6\u2009months before the presentation and was found to have right atrial (RA) thrombus with pulmonary embolism and extensive retrograde venous extension 1 month prior. Review of studies done at her local institution revealed 10\u2009mmHg mean gradient (MG) across the bioprosthetic TV that was only reported as mild\u2013moderate TS. Echocardiography done at our instruction confirmed suspicion of severe TS with calcified immobile leaflets. Computed tomography showed persistent RA thrombus and therefore surgical replacement of the TV was undertaken. Subsequently, patient\u2019s dyspnoea rapidly improved.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion\u2003<\/jats:title>\n                  <jats:p>Progressive dyspnoea and symptoms of right heart failure in a patient with a history of bioprosthetic TV replacement should be investigated for prosthetic valve dysfunction. Due to its rarity, TS diagnosis can be overlooked on routine echocardiography. In our patient, despite a measured MG of 10\u2009mmHg, the presence of critical TS was not initially recognized. As TS is associated with increased thrombogenic potential and given the rare occurrence of in situ RA thrombosis, physicians must have a high index of suspicion for TS in the appropriate clinical context.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab169","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T02:49:36Z","timestamp":1620874176000},"source":"Crossref","is-referenced-by-count":2,"title":["Severe tricuspid bioprosthetic valve stenosis as an unusual cause of pulmonary embolism: a case report"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6210-7669","authenticated-orcid":false,"given":"Jwan A","family":"Naser","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7398-0738","authenticated-orcid":false,"given":"Arman","family":"Arghami","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mackram F","family":"Eleid","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5256-3150","authenticated-orcid":false,"given":"Sorin V","family":"Pislaru","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,5,12]]},"reference":[{"key":"2021070816561679400_ytab169-B1","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/j.echo.2014.08.008","article-title":"Frequency and significance of right atrial appendage thrombi in patients with persistent atrial fibrillation or atrial flutter","volume":"27","author":"Cresti","year":"2014","journal-title":"J Am Soc Echocardiogr"},{"key":"2021070816561679400_ytab169-B2","doi-asserted-by":"crossref","first-page":"200","DOI":"10.7326\/0003-4819-126-3-199702010-00004","article-title":"Cardioversion guided by transesophageal echocardiography: the ACUTE pilot study. 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