{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T18:47:26Z","timestamp":1782154046810,"version":"3.54.5"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Native aortic valve thrombosis (NAVT) is an uncommon cause of coronary embolism and myocardial infarction. In patients with severe aortic valve disease treated surgically, a post-operative communication between the left ventricle and right atrium (i.e. acquired Gerbode defect) is a rare complication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We report the case of a 67-year-old man with suspected NAVT presenting with myocardial infarction and a post-operative acquired Gerbode defect. Coronary angiography showed a floating thrombus in the left main coronary artery without significant culprit-vessel atherosclerotic disease, suggesting coronary embolism. Multiple aspiration thrombectomies and glycoprotein IIb\/IIIa inhibitor therapy were performed. Recurrent chest pain prompted repeat coronary angiography, which confirmed thrombus recurrence and resolution after repeat treatment. Intravascular ultrasound excluded significant culprit-vessel atherosclerotic disease. Aspirated material revealed a subacute thrombus with microcalcifications on histopathological examination. Echocardiography showed severe calcific aortic stenosis, a likely predisposing factor for NAVT. Atrial fibrillation had not been documented during the embolic event or previously and was only detected later during hospitalization, prompting initiation of anticoagulation (CHA2DS2-VASc score 3). Consequently, dual antiplatelet therapy was replaced with apixaban and ticagrelor until surgery. After clinical stabilization, the patient underwent surgical aortic valve replacement. No left atrial appendage thrombus was found intra-operatively after 3 months of anticoagulation. Post-operatively, multimodal imaging identified and quantified an acquired Gerbode defect. Given its haemodynamic insignificance, a conservative approach was adopted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights underreported complications of severe aortic stenosis and its treatment, emphasizing the importance of multimodal imaging in the diagnosis of NAVT and post-operative Gerbode defect.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag447","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:35:08Z","timestamp":1781004908000},"source":"Crossref","is-referenced-by-count":0,"title":["Suspected native aortic valve thrombosis complicated by recurrent left main coronary artery embolism and acquired Gerbode defect: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5413-873X","authenticated-orcid":false,"given":"Gabriela","family":"Lipo\u0161\u0107ak","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, General Hospital \u2018Dr. An\u0111elko Vi\u0161i\u0107 \u2019, Antuna Mihanovi\u0107a 8, Bjelovar 43000 ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8829-2543","authenticated-orcid":false,"given":"Nikola","family":"Kos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Hospital Center Sisters of Charity , Vinogradska cesta 29, Zagreb 10 000 ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9707-6946","authenticated-orcid":false,"given":"Kre\u0161imir","family":"Kordi\u0107","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Hospital Center Sisters of Charity , Vinogradska cesta 29, Zagreb 10 000 ,","place":["Croatia"]},{"name":"School of Medicine, Catholic University of Croatia , Ilica 244, Zagreb 10 000 ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1242-3575","authenticated-orcid":false,"given":"Lucija","family":"Svetina","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Center Zagreb , Ki\u0161pati\u0107eva 12, Zagreb 10 000 ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4236-7594","authenticated-orcid":false,"given":"Ozren","family":"Vinter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Hospital Center Sisters of Charity , Vinogradska cesta 29, Zagreb 10 000 ,","place":["Croatia"]},{"name":"School of Medicine, Catholic University of Croatia , Ilica 244, Zagreb 10 000 ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"2026062213513093700_ytag447-B1","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.jacc.2021.06.023","article-title":"The characteristics and outcomes of native aortic valve thrombosis: a systematic review","volume":"78","author":"Alajaji","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026062213513093700_ytag447-B2","article-title":"The Gerbode defect: a case series","volume":"5","author":"Sunderland","year":"2021","journal-title":"Eur Heart J Case Rep"},{"key":"2026062213513093700_ytag447-B3","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.jsha.2017.01.006","article-title":"Gerbode defect: a comprehensive review of its history, anatomy, embryology, pathophysiology, diagnosis, and treatment","volume":"29","author":"Saker","year":"2017","journal-title":"J Saudi Heart Assoc"},{"key":"2026062213513093700_ytag447-B4","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"2026062213513093700_ytag447-B5","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12947-026-00367-5","article-title":"Cardioembolic sources and stroke prevention: a systematic review","volume":"24","author":"Cozza","year":"2026","journal-title":"Cardiovasc Ultrasound"},{"key":"2026062213513093700_ytag447-B6","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1161\/CIRCULATIONAHA.115.018172","article-title":"Systemic embolic events (SEE) in atrial fibrillation: SEEing embolic risk more clearly","volume":"132","author":"Chatterjee","year":"2015","journal-title":"Circulation"},{"key":"2026062213513093700_ytag447-B7","doi-asserted-by":"crossref","first-page":"5112","DOI":"10.1038\/s41598-020-59526-x","article-title":"The distinctive structure and composition of arterial and venous thrombi and pulmonary emboli","volume":"10","author":"Chernysh","year":"2020","journal-title":"Sci Rep"},{"key":"2026062213513093700_ytag447-B8","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.022505","article-title":"Cardiac computed tomography versus transesophageal echocardiography for the detection of left atrial appendage thrombus: a systematic review and meta-analysis","volume":"10","author":"Yu","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2026062213513093700_ytag447-B9","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1161\/CIRCIMAGING.112.000153","article-title":"Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis","volume":"6","author":"Romero","year":"2013","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026062213513093700_ytag447-B10","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2021.651726","article-title":"Non-invasive imaging in the evaluation of cardiac shunts for interventional closure","volume":"8","author":"Pushparajah","year":"2021","journal-title":"Front Cardiovasc Med"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag447\/68506190\/ytag447.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/6\/ytag447\/68506190\/ytag447.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/6\/ytag447\/68506190\/ytag447.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T17:51:39Z","timestamp":1782150699000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag447\/8705319"}},"subtitle":[],"editor":[{"given":"Christoph","family":"Sinning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Ahmet Taha","family":"Sahin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":10,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag447","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,6,1]]},"article-number":"ytag447"}}