Unconventional modified Fontan operation for Ebstein's anomaly
Bibliographic record
Abstract
A 48-year-old woman presented with progressive exercise intolerance and paroxysmal atrial fibrillation. The past history was remarkable for severe Ebstein's anomaly and hypoplastic right ventricle, for which she had undergone placement of a 30 mm Carpentier-Edwards right atrial to right ventricular outflow tract conduit at 20 years of age. She subsequently required conduit revision with a 26 mm pulmonary cryopreserved homograft due to symptomatic conduit obstruction at the age of 24 years. Physical examination revealed mid-systolic click, widely split S2 and Grade 2/6 ejection systolic murmur at the heart base. Transthoracic echocardiography was technically difficult. Transoesophageal echocardiography demonstrated the conduit arising from the mid-portion of right atrial free wall with a moderately regurgitant bioprosthetic valve measuring 15 mm proximally. The conduit progressively narrowed distally to 7 mm just before the right ventricular outflow tract anastomosis. Ebstein's malformation with moderate tricuspid valve regurgitation was noted (Figure 1A; see Supplementary data online, Video S1). Cardiovascular magnetic resonance demonstrated findings similar to echocardiography. Additionally, severe right atrial dilation and a small functional right ventricle with mildly reduced systolic function (ejection fraction = 43%) were seen (Figure 1B and C; see Supplementary data online, Videos S2–S4). Balloon occlusion of the conduit for up to 5 min at cardiac catheterization had no impact on the patient's haemodynamics, suggesting that the conduit was not contributing importantly to right atrial–right ventricular flow. A decision was made to proceed with conduit excision and tricuspid valve repair.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 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".