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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Computed tomography angiography showing a non-occlusive thrombus in the conduit &#40;asterisk&#41;&#59; &#40;B&#41; three-dimensional reconstruction of the patient&#39;s complex cardiac anatomy&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A male patient underwent heterotopic heart transplantation at the age of 16 years for dilated cardiomyopathy and advanced heart failure &#40;HF&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Twenty years after transplantation he developed refractory symptomatic HF and underwent percutaneous closure of the aortic valve of the native heart &#40;NH&#41; with an Amplatzer device &#40;due to severe aortic regurgitation causing reduction in systemic cardiac output&#41; and surgical connection of the right ventricle &#40;RV&#41; of the donor heart &#40;DH&#41; to the native pulmonary artery via a conduit &#40;due to severe tricuspid regurgitation &#91;TR&#93; in the NH causing reduction in pulmonary blood flow&#41;&#46; Post-procedural thoracic computed tomography angiography &#40;CTA&#41; showed a thrombus inside the conduit&#46; The patient&#39;s complex cardiac anatomy is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After three months of anticoagulant and antiplatelet therapy&#44; echocardiographic assessment showed a severely dilated NH with biventricular dysfunction &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41; and signs of right ventricular pressure overload in the DH &#40;severe TR&#59; right ventricular&#47;right atrial gradient 54 mmHg&#59; reduced right ventricular systolic function with fractional area change of 20&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41;&#46; The conduit also appeared to be occluded&#44; best seen in three-dimensional &#40;3D&#41; view &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#44; arrow&#41;&#46; CTA confirmed persistence of a non-occlusive thrombus in the conduit &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>A&#44; asterisk&#41;&#46; 3D reconstruction provided a better appreciation of the relationship between the two hearts &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>B&#41;&#46; After several unsuccessful attempts to recanalize the conduit&#44; the patient is now in New York Heart Association functional class II under optimal medical therapy&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">This unusual case of a patient who underwent heterotopic heart transplantation underlines the crucial role of multimodal imaging in the management and follow-up of patients with complex cardiac anatomy&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" 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; Torres S&#44; Amorim S&#44; Vasconcelos M&#44; Sousa C&#44; Maciel MJ&#44; Macedo F&#46; Dois cora&#231;&#245;es&#58; um caso complexo de insufici&#234;ncia card&#237;aca&#46; Rev Port Cardiol&#46; 2019&#59;38&#58;515&#8211;517&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of the patient&#39;s cardiac anatomy&#46; IVC&#58; inferior vena cava&#59; LA&#58; left atrium&#59; LV&#58; left ventricle&#59; PA&#58; pulmonary artery&#59; PVs&#58; pulmonary veins&#59; RA&#58; right atrium&#59; RV&#58; right ventricle&#59; SVC&#58; superior vena cava&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography showing native heart &#40;A&#41; with severely dilated chambers and Amplatzer device at the site of the aortic valve&#44; and donor heart &#40;B&#41; with mild dilatation of the right ventricle and severe tricuspid regurgitation&#46;</p>"
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        "texto" => "<p id="par0185" class="elsevierStylePara elsevierViewall">The authors thank Dr&#46; Ant&#243;nio Madureira&#44; from the Radiology Department of Centro Hospitalar Universit&#225;rio de S&#227;o Jo&#227;o&#44; for his work with the cardiac computed tomography&#46;</p>"
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