Complex congenital fistula between coronary arteries, bronchial arteries, and pulmonary artery assessed with cardiac computed tomography
Bibliographic record
Abstract
A 36-years-old healthy athlete showed a typical postero-septal accessory pathway with left ventricular pre-excitation at warm-up, during routine screening ECG evaluation (Panels A–I). The ECG alteration disappeared during the exercise in the absence of symptoms and other abnormalities. Physical examination was normal and the family history was unremarkable for heart disease. The athlete underwent two-dimensional trans-thoracic echocardiography to exclude the underlying cardiac diseases; Colour-Doppler examination revealed an anomalous diastolic jet of flow directed into the main pulmonary artery trunk on the left side. A coronary artery fistula was suspected even though left-to-right shunt was not significant (Qp/Qs ratio 1.2) and there were no signs of pulmonary or systemic overload. Cardiac computed tomography (CCT) was performed and it showed a complex fistula originating from all the proximal coronaries and draining into the main pulmonary artery (Panels A–I; Supplementary material online, Video S1–3). In particular, CCT showed a large vascular malformation (17x17x9 mm) constituted by multiple fistulous communications between coronary arteries, bronchial arteries, and the pulmonary (Panels A–I; Supplementary material online, Video S1–3). Coronary angiography confirmed the presence of numerous fistulas with coronary-pulmonary Left to Right moderate shunt as well as another communication between the descending aorta and a branch of the pulmonary artery with epicardial coronary disease-free (Supplementary material online, Video S4). In view of the lack of symptoms and signs of ventricular overload, the athlete was considered eligible for competitive sport but require to be monitored with ECG + echocardiography every 6 months. Panels: Cardiac CT and conventional coronary angiography findings. ECG showed typical postero-septal accessory pathway with LV pre-excitation (A). Echocardiography revealed an anomalous diastolic jet of flow directed into the main pulmonary artery trunk on the left side (B). Cardiac CT (C–F) showed a large artero-venous plexus, originating from all three proximal segments of the coronary arteries, fistulizing into the pulmonary artery trunk (C; arrowhead) and surrounding the main pulmonary artery (D; arrowheads). The fistula showed a main body right on top of the proximal segment of the main pulmonary artery (D–F; asterisk) and also connection with bronchial arteries (E, F; arrowheads). Conventional coronary angiography confirmed the findings (G–I; arrowheads). Ao, Ascending Aorta; PA, Pulmonary artery; MV, Mitral Valve. Supplementary material is available at European Heart Journal online.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| 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".