Coronary Artery Distortion and Revision in Children with Supravalvar Aortic Stenosis Undergoing Aortic Sinus Enlargement
Bibliographic record
Abstract
All articles of this category Objectives: Aortic sinus enlargement in patients with supravalvar aortic stenosis (SVAS) alters the geometry of the coronary sinuses, which may cause coronary artery kinking and stenosis. We sought to analyze the incidence of coronary artery distortion and its impacts on clinical outcomes. The effectiveness of surgical revision on the restoration of coronary artery flow was also analyzed. Methods: 47 patients with SVAS repaired between 2000 and 2014 were included. Median age at operation was 1.1years (IQR: 0.31–4.48), median body weight 9.4kg (IQR: 6.03–14.60) Repair was performed with one (12 [25.5%], G1), two (32 [68.1%], G2) or three (3 [6.4%], G3) sinus enlargement. Primary right coronary artery (RCA) reimplantation into the sinus patch was performed in 7 (14.9%) patients. Coronary artery flow patterns were assessed with transesophageal echocardiography intraoperatively and coronary artery stenosis was defined when there was a high peak velocity and/or systolic flow reversal. Median follow-up was 1.34 years (IQR: 0.1–6.55). Results: There were no differences in cardiopulmonary bypass (CPB) and aortic cross-clamp time between the three patching techniques ( p = 0.650/0.659). Revision for RCA distortion was performed intraoperatively in 14 (29.8%) patients, LCA revision in 2 (4.3%). Coronary revision techniques included patch plication (9 [64.3%]), division of adventitia (5 [35.7%]), re-patching (5 [35.7%]) or coronary reimplantation (3 [21.4%]). RCA revision led to a significant reduction of mean gradient by 2.5 ± 2.2 mm Hg ( p = 0.014) and peak gradients by 3.6 ± 4.5 mm Hg ( p = 0.041), and achieved comparable mean gradients compared with non-revised controls (revision group 1.4 ± 1.9 mm Hg versus non-revision group 1.6 ± 1.1 mm Hg, p = 0.811). There was no difference in 1-year survival between revision and non-revision groups (revision: 89.1% vs. no-revision: 91.7% p = 0.752). Coronary revision was necessary in patients with two sinus enlargement only. Coronary revision was not associated with postoperative cardiac arrest, ECMO, or reintervention. Conclusion: Coronary artery distortion with right coronary sinus patching is relatively common in two sinus enlargement but can be addressed intraoperatively without negative impact on subsequent coronary flow pattern and clinical outcomes. Thorough intraoperative assessment of coronary flow is mandatory to ensure optimal outcome.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".