{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:55Z","timestamp":1753876315699,"version":"3.41.2"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["214198"],"award-info":[{"award-number":["214198"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>After an atrial switch operation, baffle complications such as stenosis and dehiscence are common. While thromboembolic events attributed to baffle leaks are well known, thrombosis at the pulmonary venous baffle as a source of cardioembolic stroke has not been previously reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We describe the case of a 43-year-old Caucasian male with recurrent cardioembolic strokes due to a calcified, broken, and thrombosed baffle with floaty, anticoagulant-resistant thrombi adhered to the side of the pulmonary venous return of Mustard patch. Surgery was the only curative option due to thrombi recurrence under different regimes of anticoagulation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>A case of recurrent cardioembolic strokes long after Mustard surgery due to thrombi on a heavily calcified pericardial patch is presented. A fracture in the patch led to the exposure of thrombogenic material, which had accumulated around the pacemaker (PM) leads on the systemic venous side of the baffle. This exposure allowed thrombotic material to reach the pulmonary venous side, ultimately entering the subaortic right ventricle and the systemic circulation. In the Mustard procedure, the material used for the baffle construction is prone to degeneration and calcification over time. We hypothesize that chronic mechanical stress from the PM leads might have contributed to the gradual erosion and fracture and consequently thrombosis of the heavily calcified patch, leading to recurrent strokes. Surgery became necessary as aggressive anticoagulation failed to prevent thrombus recurrence.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf150","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T15:33:33Z","timestamp":1743262413000},"source":"Crossref","is-referenced-by-count":1,"title":["A calcified, eroded, and thrombosed Mustard: recurrent embolic strokes in a patient with dextro-transpostion of the great arteries corrected by atrial switch\u2014case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9904-0402","authenticated-orcid":false,"given":"Francisco Javier","family":"Ruperti-Repilado","sequence":"first","affiliation":[{"name":"Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV , Avenida Manuel Siurot s\/n., 41013 Sevilla ,","place":["Spain"]},{"name":"European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), Meibergdreef 9, 1105 AZ Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Division of Cardiology, University Hospital of Basel, University of Basel , Spitalstrasse 2, 4056 Basel ,","place":["Switzerland"]},{"name":"Cardiovascular Research Institute Basel, Division of Cardiology, University Hospital Basel , Spitalstrasse 2, 4056 Basel ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amadeo","family":"Wals-Rodriguez","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV , Avenida Manuel Siurot s\/n., 41013 Sevilla ,","place":["Spain"]},{"name":"European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), Meibergdreef 9, 1105 AZ Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel Angel","family":"Japon","sequence":"additional","affiliation":[{"name":"Department of Pathology, University Hospital Virgen del Rocio , Avenida Manuel Siurot s\/n., 41013 Seville ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Gonzalez-Calle","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV , Avenida Manuel Siurot s\/n., 41013 Sevilla ,","place":["Spain"]},{"name":"European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), Meibergdreef 9, 1105 AZ Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Department of Cardiovascular Surgery, University Hospital Virgen del Rocio , Avenida Manuel Siurot s\/n., 41013 Seville ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2115-5047","authenticated-orcid":false,"given":"Pastora","family":"Gallego","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV , Avenida Manuel Siurot s\/n., 41013 Sevilla ,","place":["Spain"]},{"name":"European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), Meibergdreef 9, 1105 AZ Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"2025041510353916900_ytaf150-B1","first-page":"1301","article-title":"Improved national prevalence estimates for 18 selected major birth defects\u2014United States, 1999-2001","volume":"54","author":"Centers for Disease Control and Prevention (CDC)","year":"2006","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025041510353916900_ytaf150-B2","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1161\/01.CIR.40.2.237","article-title":"Natural history of transposition of the great arteries. 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