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            "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Coronary angiogram showing chronic total occlusion of the left main coronary artery and critical left anterior descending lesion proximal to left internal mammary artery anastomosis&#59; &#40;C&#41; coronary computed tomography angiography showing a short &#40;9 mm&#41;&#44; hardly calcified chronic total occlusion lesion&#58; in the middle of the occlusion 100&#37; of the coronary lumen &#40;186 Hounsfield units&#41; was calcified and&#44; in the distal part&#44; 75&#37; of the wall circumference &#40;933 Hounsfield units&#41; was calcified&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 27-year-old woman was admitted to our center after emergency vascular surgery for spontaneous dissection of the left iliac artery&#46; Congenital factor VIII deficiency and family history of complicated brain aneurysm were previously reported&#46; Hemoperitoneum and hemothorax were identified after surgery as consequences of a severe coagulation disorder and the patient suffered cardiac arrest with pulseless electrical activity&#46; A portable echocardiograph detected pericardial effusion and emergency blind subxiphoid pericardiocentesis was performed with recovery of pulse&#46; An urgent cardiology evaluation was subsequently required&#46; Transthoracic echocardiography views were severely limited&#44; so it was decided to undertake transesophageal echocardiography&#46; This revealed a catheter crossing the aortic valve to the ascending aorta &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; Contrast-enhanced computed tomography angiography confirmed the intravascular placement of a drainage with its distal tip in the proximal segment of the left carotid artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; The ventricular insertion point was in the anterior interventricular groove&#44; close to the distal segment of the left anterior descending coronary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46; Prior to entering the operating room&#44; the patient suffered a new cardiac arrest and resuscitation maneuvers were ineffective&#46; Subsequent autopsy revealed systemic vascular and tissue fragility &#40;spontaneous liver and spleen lacerations&#44; aortic rupture and hyoid bone fracture with minimal procedural manipulation&#41;&#44; compatible with a diagnosis of type 4 Ehlers-Danlos syndrome&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">This report has two key messages&#46; Pericardiocentesis is not free from severe complications and should be performed with imaging whenever possible&#46; Moreover&#44; a congenital connective tissue disorder should be suspected in young patients with spontaneous arterial complications&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">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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