{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:33:42Z","timestamp":1760747622698,"version":"build-2065373602"},"reference-count":0,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2018,7,26]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Clinical introduction<\/jats:title>\n                  <jats:p>A 59-year-old woman visited an outpatient cardiology clinic due to shortness of breath on exertion. Physical examination showed no significant abnormality of vital signs. A III\/VI systolic murmur was heard on the fourth intercostal space at the right sternal border. The majority of laboratory tests were normal. Chest X-ray showed a curved\u00a0vessel shadow (figure 1A). Initial transthoracic echocardiography showed abnormal blood flow into the inferior vena cava (IVC) in the subxiphoid long axis view (figure 1B) and mild right heart dilatation (online\u00a0supplementary figure 1). Transoesophageal echocardiography showed severe tricuspid regurgitation (online supplementary figure 2).<\/jats:p>\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 in the subxiphoid long axis view.<\/jats:p>\n                     <\/jats:caption>\n                     <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"heartjnl-2018-313655f1\" position=\"float\" orientation=\"portrait\"\/>\n                  <\/jats:fig>\n                  <jats:supplementary-material id=\"SP1\" position=\"float\" orientation=\"portrait\">\n                     <jats:label>Supplementary data<\/jats:label>\n                     <jats:p>\n                        <jats:inline-supplementary-material xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"ss1\" xlink:href=\"SP1.jpg\" mimetype=\"image\" mime-subtype=\"jpeg\"\/>\n                     <\/jats:p>\n                  <\/jats:supplementary-material>\n                  <jats:supplementary-material id=\"SP2\" position=\"float\" orientation=\"portrait\">\n                     <jats:label>Supplementary data<\/jats:label>\n                     <jats:p>\n                        <jats:inline-supplementary-material xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"ss2\" xlink:href=\"SP2.jpg\" mimetype=\"image\" mime-subtype=\"jpeg\"\/>\n                     <\/jats:p>\n                  <\/jats:supplementary-material>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Question<\/jats:title>\n                  <jats:p>What is the most likely underlying disease for the patient\u2019s shortness of breath on exertion?<jats:list list-type=\"alpha-upper\">\n                        <jats:list-item>\n                           <jats:p>Pulmonary arteriovenous fistula.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Pulmonary arterial hypertension.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Lung cancer.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Partial anomalous pulmonary venous connection.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                           <jats:p>Isolated tricuspid regurgitation.<\/jats:p>\n                        <\/jats:list-item>\n                     <\/jats:list>\n                  <\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2018-313655","type":"journal-article","created":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T12:19:02Z","timestamp":1533817142000},"page":"110-110","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Woman in her 50s with shortness of breath on exertion"],"prefix":"10.1136","volume":"105","author":[{"given":"Takao","family":"Konishi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan"},{"name":"Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hironori","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinya","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,8,9]]},"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2018-313655","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T18:49:56Z","timestamp":1760726996000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2018-313655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,9]]},"references-count":0,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,1,3]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/heartjnl-2018-313655"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2018-313655","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"type":"print","value":"1355-6037"},{"type":"electronic","value":"1468-201X"}],"subject":[],"published":{"date-parts":[[2018,8,9]]}}}