Hypoplasia of the posterior mitral valve leaflet detected in late adulthood
Bibliographic record
Abstract
A 76-year-old male with a pacemaker presented with acute pulmonary oedema requiring invasive mechanical ventilation. Transthoracic echocardiography (TTE) revealed a partially flail anterior mitral leaflet, severe mitral regurgitation (MR), and pulmonary hypertension, not present on previous TTEs. Transoesophageal echocardiography (TEE) demonstrated an elongated anterior mitral valve leaflet (AMVL) with a flail A2 segment due to chordal rupture (Panels 1-A, 1-B, and Supplementary Data), a hypoplastic posterior mitral valve leaflet (PMVL, black arrow head in Panels 1-A and 2) with intact chord, and severe, posteriorly directed MR (Panel 1-B) (all mid-oesophageal views, 0°). Three-dimensional TEE short-axis view of the MV, as seen from the left atrium (Panel 3 and Supplementary Data), demonstrated the hypoplastic PMVL (black arrow head) and myxomatous AMVL (A1, A2, A3 scallops) with ruptured chordae (white arrows). The patient underwent minimally invasive mitral valve repair, including ring annuloplasty and chordal transfer from the posterior annulus to A2. The absence of the PMVL is usually fatal in utero, while deficient PMVLs typically present in childhood with symptomatic MR. A few cases have been described in asymptomatic teens and adults. Our case represents the oldest documented patient with a deficient PMVL. It illustrates that a hypoplastic PMVL may be asymptomatic through to late adulthood, with valve competence maintained by an elongated AMVL. In this case, severe MR was caused by chordal rupture of the myxomatous AMVL rather than the deficient PMVL. Hypoplastic PMVLs may be more prevalent in asymptomatic adults than currently recognized.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".