Inadvertent complication of the Senning procedure
Bibliographic record
Abstract
A 34-year-old man with complete transposition of the great arteries (D-TGA) presented for the first time to our clinic. He previously underwent balloon atrial septostomy (Rashkind procedure) early after birth followed by a Senning procedure at the age of 2 months together with ligation of a patent ductus arteriosus. He has been asymptomatic since his surgery. Transthoracic echocardiogram was technically challenging yet revealed a mildly dilated, hypertrophied systemic right ventricle with mild systolic dysfunction, normal sub-pulmonary left ventricular size and systolic function with no baffle leak or stenosis. No significant valvulopathy was noted (Movie). Cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CCT) showed a moderately hypertrophied systemic right ventricle with normal systolic function (right ventricular ejection fraction 48 %). The sub-pulmonic left ventricle was dilated with normal systolic function. Systemic venous baffles were patent. The pulmonary venous portion of the baffle was patent. The main pulmonary artery and both branches were dilated (Fig. 1). Fig. 1 a CMR short-axis steady-state free precession (SSFP) coronal image showing hypertrabeculated systemic RV with dilated LV. b CMR angiography revealing the left lower PV draining superiorly to a larger common left-side PV ... CMR angiography and CCT uncovered a tortuous varix of the left lower pulmonary vein (PV) draining superiorly to a larger common left-side PV which in turn connected to the superior aspect of the left atrium to the left of the Senning baffle (residual left-to-right shunt). Qp:Qs ratio was estimated at 1.9 by flow data and 2.1 by stroke volume analysis. The right PVs were dilated (Fig. 1). Due to the presence of significant residual left-to-right shunt with a dilated sub-pulmonic ventricle, cardiac catheterisation and potential corrective surgery were recommended. However, the patient declined the procedure. To the best of our knowledge, this is the first case in the literature exploring an unusual anomalous PV connection in a patient with D‑TGA following atrial switch procedure. We speculate that the patient had this anomalous connection since birth but may have been overlooked during surgical correction [1–3].
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.003 | 0.005 |
| 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".