Bicuspid aortic valve repair with external subannular ring: a case report
Bibliographic record
Abstract
Annuloplasty is a key component of bicuspid aortic valve (BAV) repair for severe aortic insufficiency (AI).Reduction of the annular diameter enhances leaflet coaptation, while annular stabilization prevents subsequent dilation, which can lead to recurrent AI and repair failure.Several techniques have been described, including valve-sparing root reimplantation (VSRR), subcommissural annuloplasty (SCA), suture annuloplasty, and external subannular ring (ESAR).At our institution, BAV repair with VSRR is performed in patients with severe AI and an aortic root aneurysm (>4.5 cm).For those presenting with a BAV and severe AI without root enlargement, concomitant SCA is performed when the preoperative annulus is ≤27 mm, while ESAR is employed when the annulus measures >27 mm.A 44-year-old male with known BAV presented to our institution with severe AI and in New York Heart Association (NYHA) Class III heart failure.Pre-procedure transesophageal echocardiogram revealed an annular measurement of 34 mm.Intraoperative inspection of the aortic valve showed a left-right Sievers 1 phenotype with severe calcification confined to the raphe.A BAV repair was performed, which consisted of debridement of calcium from the raphe, triangular resection of the conjoined leaflet, and ESAR.The patient was discharged home after an uneventful post-operative course.At 3-year follow-up, surveillance echocardiogram showed a durable repair without AI and normal left ventricular function.This case report and associated surgical video demonstrates our step-by-step approach to primary BAV cusp repair with an ESAR.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.008 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 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".