Abstract 19087: Improved Survival After Percutaneous Stenting of the Atrial Septum in Human Fetal Left Atrial Hypertension
Bibliographic record
Abstract
Hypoplastic left heart syndrome with a highly restrictive or intact atrial septum (HLHS-RAS) has a very high mortality. The associated fetal LA hypertension results in abnormal lung development with lymphangiectasia and pulmonary vein muscularization. We report our experience of ultrasound-guided stenting of the human fetal atrial septum. Methods and Results. Retrospective review of fetuses with HLHS-RAS or a variant that underwent active perinatal management from 2000-January 2012. Ten fetuses were identified. Two fetuses became hydropic and died in utero (33, 29 weeks). Four fetuses required the urgent creation of an atrial communication immediately after birth but subsequently died (5-54 days), secondary to pulmonary hypertension. More recently, the atrial septum was stented in four fetuses at 28-36 weeks without maternal general anesthesia. Elevated left atrial pressure, massive dilatation of the pulmonary veins and MRI estimated pulmonary perfusion all improved after stenting. Two fetuses developed stent stenosis with recurrence of LA hypertension in utero for approximately four weeks and 1 day respectively. Three of four stented fetuses were born by vaginal delivery. Atrial septectomy and additional procedures were performed within 72 hours of birth. Intraoperative lung biopsy demonstrated muscularized pulmonary veins and lymphangiectasia in all four. Two died at 17 and 53 days of age from pulmonary hypertension and sepsis, respectively. The other two are still alive, a significant improvement in survival (p=0.03). Conclusion. Fetal left atrial decompression by stenting may improve survival in HLHS-RAS.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".