Severe Form of Tetralogy of Fallot: Late Presentation
Bibliographic record
Abstract
A 25-year-old man was evaluated due to progressive exercise intolerance and desaturation in the setting of previously documented Tetralogy of Fallot (TOF). He was diagnosed with TOF shortly after birth but his family declined surgery. Three years earlier, he had undergone left sided modified Blalock-Taussig shunt as a palliative procedure due to progressive shortness of breath and desaturation (O2 saturation between 80-85%). Initially, in the first few months after the procedure, he noticed slight improvement of his symptoms. However, he developed progressive exercise intolerance and desaturation which mandated complete repair. Physical examination was remarkable for desaturation (O2 saturation between 85-90%), clubbing and systolic ejection murmur (grade II-III/VI) over the pulmonic area. Electrocardiogram showed right axis deviation and right ventricular (RV) hypertrophy. Chest X-ray revealed dilated right side of the heart. Transthoracic echocardiogram (TTE) was technically difficult still showed dilated hypertrophied RV with normal systolic function, malalignment ventricular septal defect (VSD) and overriding of the aorta (Supplementary movie 1 and 2). Transesophageal echocardiogram (TEE) was carried out for further delineation of the RV outflow tract (RVOT) which was hypoplastic with a long (~4 cm) segment of narrowing and significant infundibular narrowing (by hypertrophied muscle bundle). Peak gradient across the RVOT was approximately 35-40 mm Hg (Fig. 1, Supplementary movie 3 and 4). Cardiac magnetic resonance (CMR) was technically challenging due to patient's non-compliance with breathing instructions, yet confirmed the findings of TTE/TEE. Additionally, CMR uncovered hypoplastic proximal main pulmonary artery (PA), dilated left PA and mild proximal right PA stenosis with hypoplasia throughout the course (Fig. 2, Supplementary movie 5). The patient underwent successful complete repair with RV to PA conduit, resection of the native RVOT muscle bundles, arterioplasty of the right PA and VSD pericardial patch closure. Surgery was uneventful. Fig. 1 A: Transesophageal echocardiogram (TEE) transgastric view showing dilated right ventricle with significant hypertrophy. B: TEE apical long axis view showing overriding of the ascending aorta with malalignment ventricular septal defect (arrow). C: TEE ... Fig. 2 A: Cardiac magnetic resonance (CMR) sagittal image showing overriding of the ascending aorta with malalignment ventricular septal defect (arrow). B: CMR sagittal image showing hypoplastic right ventricular outflow tract and proximal main pulmonary artery ... An amalgamated approach of echocardiogram and CMR offers a precise detailed assessment of the RV, RVOT, and PA, which is critical for decision making regarding surgical intervention in this unusual case of unrepaired TOF presenting late in adult life.1),2)
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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) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".