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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old man had been referred to our department in 1978 at age 22 with a diagnosis of congenital cyanotic heart disease&#44; and had undergone ventricular &#40;VSD&#41; and atrial septal defect &#40;ASD&#41; closure and repair of pulmonary valve stenosis&#46; The chest X-ray showed mesocardia&#46; He began to experience signs and symptoms of heart failure in 1992&#44; with a systolic murmur audible over the left sternal border&#46; Serial transthoracic echocardiography &#40;TTE&#41; showed a residual high VSD&#46; Cardiac magnetic resonance imaging &#40;MRI&#41; in 1999 detected transposition of the great vessels but no VSD or ASD&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 2005&#44; the patient received an implantable cardioverter-defibrillator &#40;ICD&#41; due to syncopal ventricular tachycardia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In 2011&#44; he was hospitalized in Luxembourg for fever&#44; headache&#44; nausea and non-focal neurological alterations &#40;stupor&#41;&#46; Brain computed tomography revealed a cerebral abscess in the left medial frontal region&#44; and transesophageal echocardiography &#40;TEE&#41; identified vegetations on the defibrillator lead&#46; Blood cultures were positive for <span class="elsevierStyleItalic">Streptococcus constellatus</span> and <span class="elsevierStyleItalic">Micromonas micros</span>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Apyretic for two weeks under antibiotic therapy&#44; he was transferred to our department with the diagnoses of lead endocarditis and cerebral abscess&#44; with corrected tetralogy of Fallot without ASD or VSD&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Following repeat TTE and TEE&#44; the diagnosis of the underlying congenital heart disease was changed to congenitally corrected transposition of the great vessels and low ASD &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2&#8211;5</a>&#41;&#46; The ICD system was removed&#46; Since the patient had presented periods of third-degree atrioventricular block and was highly pacing-dependent during follow-up ICD consultations prior to hospitalization&#44; and we wished to use the minimum amount of intravascular prosthetic material&#44; a dual-chamber epicardial pacemaker and a subcutaneous ICD were implanted&#46; He was discharged clinically stable&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">It was concluded that the corrective surgery performed in 1978 resulted in a residual low ASD with a systemic-pulmonary shunt&#44; detected by TTE but not confirmed by MRI&#44; which was revealed to be the mechanism behind paradoxical systemic embolization&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although it was not possible to obtain the surgical report from the patient&#39;s medical records&#44; we found a case report<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> published by the surgeon in 1979&#44; which describes anatomical L-transposition of the great vessels&#44; supporting the current diagnosis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We highlight the importance of TTE and TEE study in the diagnosis of congenital heart disease &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; particularly to identify residual shunts&#44; which may not be detected by MRI&#46; Identification of the residual shunt in this case was the determining factor in modifying the therapeutic approach&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Cardoso G&#44; Abecasis J&#44; Ribeiras R&#44; et al&#46; Transposi&#231;&#227;o de grandes vasos congenitamente corrigida e endocardite de electrocateter&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;577&#8211;579&#46;</p>"
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                  \t\t\t\t">Great vessels parallel to the aorta in anterior position &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Morphologically right ventricle &#40;trabeculated&#41;&#44; associated with morphologically tricuspid AV valve in left position in continuity with the aortic valve and thoracic aorta &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a>&#41;&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Insertion of a morphologically tricuspid AV valve in left position lower than or in the same plane as the AV valve in right position &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#46;&nbsp;\t\t\t\t\t\t\n
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                      "doi" => "10.1136/hrt.2008.150532"
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