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      "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
      "titulo" => "Anomalous insertion of the papillary muscle in a patient with sickle cell disease&#58; A normal variant with no left ventricular outflow obstruction"
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          "titulo" => "Inser&#231;&#227;o an&#243;mala do m&#250;sculo papilar num doente com drepanocitose&#58; Uma variante do normal sem obstru&#231;&#227;o do tracto de sa&#237;da do ventriculo esquerdo"
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            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Apical 4-chamber view of the anomalous insertion of the papillary muscles in 2D transthoracic echocardiography&#46;</p>"
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    "cabecera" => "<span class="elsevierStyleTextfn">Image in cardiology</span>"
    "titulo" => "Embolization of a Biostar device in the pulmonary artery"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Transthoracic echocardiography&#59; &#40;B&#41; contrast echocardiography&#59; &#40;C&#41; 3D real-time transesophageal echocardiography&#59; &#40;D&#41; 3D off-line reconstruction of the PFO&#59; &#40;E and F&#41; cardioscopy&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An asymptomatic 50-year-old Caucasian woman was referred to our echocardiography laboratory to monitor a Biostar septal occluder device inserted six months before in order to close a patent foramen ovale&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">On transthoracic echocardiography no residual shunt was observed but the device was not identifiable &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#59; after injection of agitated saline solution in a vein of the right arm and the Valsalva maneuver&#44; a remarkable paradoxical right-to-left shunt appeared &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#44; <a class="elsevierStyleCrossRef" href="#sec0035">video clip 1</a>&#41;&#46; The estimated systolic artery pressure was 25<span class="elsevierStyleHsp" style=""></span>mmHg&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">To better understand the pathophysiology of the shunt 3D real-time transesophageal echocardiography was performed&#46; The septal occluder was not found on the interatrial septum &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46; A small interatrial defect was identified close to the foramen ovale &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#44; <a class="elsevierStyleCrossRef" href="#sec0035">video clip 2</a>&#41; with a trivial left-to-right shunt &#40;Qp&#47;Qs 1&#46;1&#41; in baseline conditions&#59; the agitated saline contrast test after the Valsalva maneuver was markedly positive&#46; Given the suspicion of distal embolization of the device&#44; cardioscopy was performed&#58; the Biostar was found in the left pulmonary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E and F&#44; <a class="elsevierStyleCrossRef" href="#sec0035">video clips 3 and 4</a>&#41;&#44; without hemodynamic effects &#40;mean pulmonary artery pressure 18<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In accordance with the clinical and instrumental findings&#44; the patient was enrolled for long-term follow-up&#44; with regular clinical and echocardiographic monitoring in order to prevent complications&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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