{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T14:17:42Z","timestamp":1781360262777,"version":"3.54.1"},"reference-count":3,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2017,12,26]]},"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Clinical introduction<\/jats:title>\n                  <jats:p>A man in his 50s with sudden-onset chest pain and dyspnoea was transferred to the emergency room. He had a history of aortic valve replacement due to aortic regurgitation with a mechanical valve 6 years previously. Heart rate was 90 bpm, and blood pressure was too low to measure. In the emergency room, he presented with severe dyspnoea and a chest X-ray showed severe lung congestion (figure 1A). ECG showed complete left bundle branch block. His respiratory status rapidly worsened, and he went into cardiopulmonary arrest. After cardiopulmonary resuscitation, transthoracic echocardiography was performed (figure 1B, online supplementary video 1).<\/jats:p>\n                  <jats:supplementary-material id=\"SP1\" position=\"float\" orientation=\"portrait\">\n                     <jats:label>Supplementary file 1<\/jats:label>\n                     <jats:p>\n                        <jats:inline-supplementary-material xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"ss1\" xlink:href=\"SP1.mov\" mimetype=\"video\" mime-subtype=\"quicktime\"\/>\n                     <\/jats:p>\n                  <\/jats:supplementary-material>\n                  <jats:fig id=\"F1\" position=\"float\" orientation=\"portrait\">\n                     <jats:label>Figure 1<\/jats:label>\n                     <jats:caption>\n                        <jats:p>(A) Chest X-ray. (B) Colour Doppler image from apical five-chamber view.<\/jats:p>\n                     <\/jats:caption>\n                     <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"heartjnl-2017-312477f1\" position=\"float\" orientation=\"portrait\"\/>\n                  <\/jats:fig>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Question<\/jats:title>\n                  <jats:p>What is the most likely cause of the patient\u2019s cardiopulmonary arrest?<\/jats:p>\n                  <jats:p>\n                     <jats:list list-type=\"alpha-upper\">\n                        <jats:list-item>\n                           <jats:p>Myocardial infarction in left main trunk<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Aortic dissection<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Prosthetic valve thrombosis<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Prosthetic valve embolisation<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Pulmonary embolism<\/jats:p>\n                        <\/jats:list-item>\n                     <\/jats:list>\n                  <\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2017-312477","type":"journal-article","created":{"date-parts":[[2018,1,30]],"date-time":"2018-01-30T12:23:28Z","timestamp":1517315008000},"page":"868-868","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Man in his 50s with chest pain and dyspnoea"],"prefix":"10.1136","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0387-8877","authenticated-orcid":false,"given":"Yuki","family":"Obayashi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chisato","family":"Izumi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihisa","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,1,30]]},"reference":[{"key":"2025092007015178000_104.10.868.1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s00414-003-0405-4","article-title":"Complete detachment of an aortic valve prosthesis 10 years after implantation","volume":"117","author":"Grubwieser","year":"2003","journal-title":"Int J Legal Med"},{"key":"2025092007015178000_104.10.868.2","first-page":"236","article-title":"Embolization of a complete prosthetic aortic valve to the abdominal aorta. Long-term survival after surgery","volume":"23","author":"Villani","year":"1996","journal-title":"Tex Heart Inst J"},{"key":"2025092007015178000_104.10.868.3","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivw087"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2017-312477","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T14:01:59Z","timestamp":1758376919000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2017-312477"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,30]]},"references-count":3,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,4,26]]},"published-print":{"date-parts":[[2018,5]]}},"alternative-id":["10.1136\/heartjnl-2017-312477"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2017-312477","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,30]]}}}