Bibliographic record
Abstract
The technical challenges and feasibility of complex paravalvular leak repair are discussed through a case based example. A frail septogenarian presented with dyspnea due to severe paravalvular mitral regurgitation. She had severe scoliosis and cardiac cachexia. There were problems with hemolysis necessitating repeated blood transfusion. Logistic EuroSCORE was 36.4% and STS score 15.5% for mortality, 53.2% morbidity or mortality. NYHA class was IV with progressive symptoms necessitating prolonged hospitalization. The surgical opinion was that redo surgery would confer excessive risk and she was declined for further open surgery. Amplatzer transcatheter paravalvular leak repair was performed using multiple devices. Predischarge there was a marked improvement in symptoms, from NYHA IV (immobile and bedbound) to NYHA II. The patient was discharged improved but remained frail. She continued to have problems with hemolysis, although the frequency of blood transfusions required declined significantly. At 3 months, the LV cavity dimension decreased from 47 mm to 38 mm, still with preserved LV systolic function. There was trace paravalvular MR, which was sustained at 6 months. Complex paravalvular leaks can be repaired with Amplatzer devices by transcatheter approach in very high risk patients. Several tools may be required to overcome anatomical challenges. A partially successful or unsuccessful initial procedure may yield an excellent final result through judicious staging and perseverance.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.012 |
| 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".