{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T16:28:43Z","timestamp":1764692923025,"version":"3.46.0"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infective endocarditis (IE) continues to show a rising global incidence and significant associated mortality. Among its complications, pseudoaneurysms (pAs) are peri-annular lesions resulting from localized tissue destruction caused by infection, leading to a focal dilatation. These lesions usually occur as isolated findings, and the presence of multiple pAs is rare. Importantly, pAs are recognized predictors of in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We describe three distinct patients exhibiting IE complicated with multiple pAs with particular and unique features. Patient 1 is a 49-year-old woman with pre-existing bicuspid aortic valve (BAV), with fever and dyspnoea; two pAs were identified (in the aortic root and mitral\u2013aortic intervalvular fibrosa) and were successfully treated with surgical resection. Patient 2 is a 51-year-old man with past history of a Bentall procedure, presented with 3-month history of fever. Two large pAs were found in the aortic root; despite successful surgical repair, the patient died secondary of refractory vasoplegic shock. Patient 3 is a 3-year-old boy, with a known BAV with 4 weeks of high-degree fever. Three pAs were identified (two in the aortic root and one in the mitral valve) along with two other congenital heart defects. Unfortunately, despite full medical treatment, patient died due to refractory cardiogenic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Multimodality imaging served as a cornerstone for the accurate diagnosis, anatomical localization, and extension of pAs in all three patients. Echocardiography helped to reveal the echo-free spaces with systolic expansion and diastolic collapse, a feature that was also observed in the cardiac angio-computed tomography. Notably, the presence of the Yin\u2013Yang sign on colour Doppler imaging served as a key diagnostic clue and should be carefully sought when evaluating patients with IE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf589","type":"journal-article","created":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T12:59:52Z","timestamp":1763211592000},"source":"Crossref","is-referenced-by-count":0,"title":["Multiple pseudoaneurysms in complicated infective endocarditis: importance of the Yin\u2013Yang sign and multimodality imaging\u2014case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3823-3825","authenticated-orcid":false,"given":"C\u00e9sar Augusto","family":"Rojas-S\u00e1nchez","sequence":"first","affiliation":[{"name":"Department of Cardiology, Centro M\u00e9dico Nacional 20 de Noviembre , Av. Felix Cuevas #540, Col. Del Valle, Del. Benito Juarez, Mexico City 03100, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7845-0974","authenticated-orcid":false,"given":"Gabriela","family":"Mel\u00e9ndez-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Imaging, Centro M\u00e9dico Nacional 20 de Noviembre , Av. Felix Cuevas #540, Col. Del Valle, Del. Benito Juarez, Mexico City 03100, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaee","family":"Alvarado-Toledo","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Centro M\u00e9dico Nacional 20 de Noviembre , Av. Felix Cuevas #540, Col. Del Valle, Del. Benito Juarez, Mexico City 03100, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gladis","family":"Faustino-Maravilla","sequence":"additional","affiliation":[{"name":"Department of Echocardiography, Centro M\u00e9dico Nacional 20 de Noviembre , Av. Felix Cuevas #540, Col. Del Valle, Del. Benito Juarez, Mexico City 03100, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heberto","family":"Aquino-Bruno","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, Centro M\u00e9dico Nacional 20 de Noviembre , Av. Felix Cuevas #540, Col. Del Valle, Del. Benito Juarez, Mexico City 03100, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"2025120211262283300_ytaf589-B1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/S0140-6736(24)01098-5","article-title":"Infective endocarditis","volume":"404","author":"Li","year":"2024","journal-title":"Lancet"},{"key":"2025120211262283300_ytaf589-B2","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.repc.2021.02.027","article-title":"Infective endocarditis: epidemiology and prognosis","volume":"41","author":"Apolin\u00e1rio","year":"2022","journal-title":"Rev Port Cardiol (Engl Ed)"},{"key":"2025120211262283300_ytaf589-B3","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.echo.2010.07.015","article-title":"Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF): a comprehensive review","volume":"23","author":"Sudhakar","year":"2010","journal-title":"J Am Soc Echocardiogr"},{"key":"2025120211262283300_ytaf589-B4","first-page":"464","article-title":"Multiple aortic pseudoaneurysms due to detachment of the composite graft after bentall operation","volume":"54","author":"Rallidis","year":"2013","journal-title":"Hellenic J Cardiol"},{"key":"2025120211262283300_ytaf589-B5","doi-asserted-by":"crossref","first-page":"E013827","DOI":"10.1161\/CIRCIMAGING.121.013827","article-title":"Rare pseudoaneurysms complicating from endocarditis","volume":"15","author":"Liu","year":"2022","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025120211262283300_ytaf589-B6","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1016\/j.jaccas.2021.07.014","article-title":"Rapidly enlarging aortic root pseudoaneurysm in a child with endocarditis and repaired congenital heart disease","volume":"3","author":"Singh","year":"2021","journal-title":"JACC Case Rep"},{"key":"2025120211262283300_ytaf589-B7","doi-asserted-by":"crossref","first-page":"1233926","DOI":"10.3389\/fcvm.2023.1233926","article-title":"Mitral valve aneurysms: echocardiographic characteristics, formation mechanisms, and patient outcomes","volume":"10","author":"Wang","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"2025120211262283300_ytaf589-B8","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/0735-1097(94)00326-L","article-title":"Pseudoaneurysms of the mitral-aortic intervalvular Fibrosa: dynamic characterization using transesophageal echocardiographic and Doppler techniques","volume":"25","author":"Afridi","year":"1995","journal-title":"J Am Coll Cardiol"},{"key":"2025120211262283300_ytaf589-B9","doi-asserted-by":"crossref","first-page":"110087","DOI":"10.1016\/j.clinimag.2024.110087","article-title":"I saw the sign: he felt a pang and we saw the Yin-Yang (sign)","volume":"107","author":"Damadian","year":"2024","journal-title":"Clin Imaging"},{"key":"2025120211262283300_ytaf589-B10","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1055\/s-0039-1677676","article-title":"Pseudoaneurysms of the peripheral arteries","volume":"28","author":"Henry","year":"2019","journal-title":"International Journal of Angiology"}],"container-title":["European Heart Journal - 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