Sudden cardiac death in transposition of the great arteries with a Mustard or Senning baffle
Bibliographic record
Abstract
PURPOSE OF REVIEW: The literature on sudden death in transposition of the great arteries (D-TGA) with atrial switch surgery is reviewed and a pathophysiological mechanism is proposed. RECENT FINDINGS: Over 80% of sudden deaths in patients with D-TGA and Mustard or Senning baffles occur during exercise. Factors most consistently associated with ventricular arrhythmias and sudden death include heart failure parameters and atrial arrhythmias. Atrial arrhythmias have been observed to trigger malignant ventricular arrhythmias. Exercise may promote 1 : 1 conduction, with inordinately high ventricular rates. Reconstructed intra-atrial pathways are associated with an impaired stroke volume response to increased heart rates. A high prevalence of perfusion defects has been reported despite the absence of coronary atherosclerosis, particularly involving the inferior wall of the systemic right ventricle. Beta-blockers have been independently associated with a lower rate of ventricular arrhythmias in patients with implantable cardioverter-defibrillators. SUMMARY: It is hypothesized that ischemia-related ventricular arrhythmias are a common mechanism for sudden death in patients with D-TGA and atrial baffles. Ischemia may be provoked by rapid heart rates from sinus or atrial arrhythmias. Myocardial oxygen supply/demand mismatch may be exacerbated by the impaired stroke volume response, hypertrophic remodeling of the pressure-loaded systemic right ventricle, and inefficient coronary circulation.
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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 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| 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 | 0.001 |
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".