Contained aortic root rupture after transcatheter aortic valve implantation
Bibliographic record
Abstract
A 94-year-old man was admitted for severe symptomatic aortic stenosis. His main co-morbidity was a rheumatoid polyarthritis requiring corticoid treatment. Physical examination showed pure aortic stenosis with no cardiac failure. Transthoracic echocardiography showed a depressed left ventricular ejection fraction of 45%, aortic valve area of 0.7 cm2, mean gradient at 53 mmHg, and systolic pulmonary artery pressure at 60 mmHg. The mortality risk (Logistic EuroSCORE) was 34% and multidisciplinary evaluation confirmed that the risk of conventional surgery was prohibitive. Transcatheter aortic valve implantation (TAVI) was considered, and screening showed normal coronary angiogram, an aortic annulus diameter of 21 mm, non-calcified femoroiliac arteries with a diameter of >7 mm. Thus, TAVI was performed, under general anaesthesia and transoesophageal echocardiography (TEE) guidance, via a transfemoral approach, using a 23 mm Edwards Sapien XT prosthesis. The procedure was uneventful. However, immediate post-implantation TEE check showed a thickening of the posterior aortic wall, suggestive of an aortic root haematoma (Panel A, arrow), whereas angiogram remained unremarkable (Panel B). A medical management was decided upon in this inoperable patient. The day after, computed tomography (CT) confirmed the diagnosis of contained aortic root rupture (Panels C and D), while it was hardly detectable on further TTE examinations (Panel E, arrow). The in-hospital course was clinically uncomplicated, and the patient was discharged at Day 7. Sudden death occurred at Day 22 (no autopsy).
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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 | 0.005 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".