Right ventricular outflow tract obstruction secondary to a membranous ventricular septal aneurysm
Bibliographic record
Abstract
A 55-year-old woman was referred for evaluation of exertional dyspnoea. She was diagnosed in childhood with a bicuspid aortic valve (BAV) and an uncomplicated small perimembranous ventricular septal defect (VSD). She remained well until the previous year, when she developed progressive NYHA II–III dyspnoea. On TTE, there was no significant stenosis or insufficiency associated with the BAV. A small perimebranous VSD was present with left to right shunting. Colour Doppler interrogation revealed significant flow acceleration in the right ventricular outflow tract (RVOT). TEE confirmed a large (5 × 5 cm) protruding ‘windsock-sock’ type membranous ventricular septal aneurysm (MVSA) obliterating the RVOT. This was associated with prominent right ventricular muscle bundles. The RVOT peak gradient was 91 mmHg. The RV systolic function was normal. There was moderate tricuspid regurgitation. The RV systolic pressure was 120 mmHg (derived from TR jet velocity, assuming right atrial pressure = 10 mmHg; systolic BP was 131 mmHg). The patient underwent repair with resection of the MVSA and the hypertrophied muscle bundles, closure of the small VSD, and annuloplasty of the tricuspid valve. Her functional status improved markedly (NYHA I) following surgery. MVSAs are commonly associated with peri-membranous VSDs and are usually benign. However, in some patients, MVSAs can become obstructive and present for the first time in adulthood. Although the most common cause of RVOT obstruction in isolated peri-membranous VSD is the formation of large right ventricular muscle bundles leading to double chamber right ventricular physiology, the presence of an obstructive MVSA should be considered (Figure 1). Figure 1 (A) Tree-dimensional image of the membranous ventricular septal aneurysm causing right ventricular outflow tract obstruction. (B) Doppler interrogation demonstrating the maximal gradient obtained across the obstruction. (C) Two-dimensional and colour Doppler image of the membranous ventricular septal aneurysm causing right ventricular outflow tract obstruction.
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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 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".