Surgical resection of an obstructive Chiari Network
Bibliographic record
Abstract
A girl born at 36 weeks gestation weighing 2.03 kg, was transferred to our hospital because of supraventricular tachycardia. Echocardiogram showed a small secundum atrial septum defect which shunted mainly right to left and a prominent Chiari network. There was no tricuspid valve regurgitation or stenosis. The right ventricular end diastolic dimension, pulmonary valve, and tricuspid annular diameter were normal for body surface area. Surprisingly by the third week of life, the infant became increasingly cyanotic with oxygen saturations between 75% and 80%, requiring supplemental oxygen. Repeat echocardiography demonstrated an exclusive right to left shunt at atrial level (see supplementary data online, Video S1). The Chiari network appeared to prolapse through the tricuspid valve orifice causing mild flow acceleration with a mean gradient of 3 mmHg in the presence of an atrial septal defect (see supplementary data online, Videos S2-S4). Repeated attempts to wean oxygen were unsuccessful, therefore the decision was made to surgically resect the obstructive Chiari network. The Chiari network was resected, in addition to resection of right ventricular muscle bundles and a creation of an adjustable atrial septal defect. After surgery, the infant maintained normal oxygen saturations at discharge. Postoperative echocardiogram showed laminar flow across the tricuspid valve with no regurgitation and left to right shunting across a small residual atrial septal defect. The Chiari network usually carries little clinical significance, however it has been associated with cyanosis, paradoxical emoboli, thrombus formation, and endocarditis. Cyanosis is usually transitory as the Chiari network often spontaneously regresses. Usually, surgical intervention is only necessary for persistent cyanosis or persistent obstruction resulting in underdevelopment of right sided heart structures. (A) Four-chamber view of the Chiari network seen prolapsing through the tricuspid valve. (B) Narrowed tricuspid valve inflow as demonstrated by colour Doppler. (C) RV inflow view of the Chiari network prolapsing through the tricuspid to the mid-ventricle. (D) Exclusive right to left shunting at atrial level. Supplementary data are available at European Heart Journal—Cardiovascular Imaging 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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| 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".