Importance of live three-dimensional transoesophageal echocardiography in the early recognition of an asymptomatic but extensive annular and left ventricular outflow track rupture following transcatheter aortic valve replacement
Bibliographic record
Abstract
An 83-year-old woman with severe aortic stenosis underwent transcatheter aortic valve replacement (TAVR) using a 29-mm (annulus = 543 mm2) Edwards Sapien XT prosthesis (Edwards Lifesciences, Irvine, CA, USA) (Panel A). Following the uneventful deployment under three-dimensional transoesophageal echocardiographic (3D-TEE; Philips Epiq 7, Philips Medical System, Andover, MA, USA) guidance, an angiographically undetected shunt (Panel B; see Supplementary data online, Video S1) from the left ventricular outflow tract to the right ventricle (RV) and a continuous flow from the anterior aortic root to the RV outflow tract were noticed (Panels C, arrows, and D; see Supplementary data online, Video S2). 3D-TEE demonstrated a large annular defect (2.1 × 0.8 cm) extending from the ventricular septum (ventricular septal defect shunt) to the aortic root (aorto-to-RV shunt) (Panel E [asterisk]; see Supplementary data online, Video S3). Given the complexity and extension of this annular rupture (Panel F [asterisk]; see Supplementary data online, Video S4), a decision was made to perform an emergent surgical repair with a pericardial patch (Panel G, arrowheads) and standard aortic valve replacement. A small residual shunt was observed at 1-month follow-up (Panel H, arrow; see Supplementary data online, Video S5).
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.009 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".