Abstract 19571: Atrial Septal Interventions After Ductal Stenting and Bilateral Pulmonary Artery Banding
Bibliographic record
Abstract
Introduction Bilateral pulmonary artery banding with arterial duct stenting (H1) leaves the state of the atrial septum unresolved. Atrial communications can become restrictive and their management is an important problem. We reviewed our experience of atrial septal interventions (ASI) in H1 patients until their second stage procedure (H2). Methods and Results A retrospective analysis of the first 66 H1 patients between 2004 and 2011. Thirty-nine (59%) of these patients had hypoplastic left heart syndrome. 34/66 (52%) patients required 42 ASI. These were performed before (n=4), during (n=5) or after H1 (n=25). An ASI was frequently required for neonates on a path to a Fontan (29/48, 60%) or being bridged to transplantation (4/10, 40%), but was rare for borderline LV (1/8, 13%). An ASI was required if there was a small ASD on the initial echocardiogram (p<0.01). A variety of percutaneous techniques were used: balloon septostomy/septoplasty (including cutting balloons), stenting and radio-frequency perforation of the atrial septum. Directly measured trans-septal mean gradient decreased from 12mmHg (range 2-25 mmHg) to 1mmHg (range 0-10mmHg). There were three ASI related deaths and 6 major complications. Three patients with LV sinusoids/fistulae experienced acute myocardial ischaemia following ASI. ASI was associated with an increased risk of death prior to H2. Conclusion Catheter techniques can produce minimally restrictive atrial communications, but can be associated with post-procedural instability. In patients with coronary sinusoids, myocardial ischaemia may occur if there is a large increase in pulmonary blood flow.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| 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 | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 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".