High-output Cardiac Failure Caused by Large Coronary Artery Fistulas Treated with Coil Embolization
Bibliographic record
Abstract
There are many causes of high-output cardiac failure. We present a unique case of high-output cardiac failure caused by multiple coronary-to-pulmonary artery (PA) fistulas, which, to our knowledge, is a rare finding that has not been previously researched. The purpose of our case report is to highlight the importance of considering coronary-to-PA fistulas in the differential diagnosis of patients presenting with high-output cardiac failure. Our patient presented to the emergency department with shortness of breath and underwent nuclear stress testing, which, through cardiac catheterization, revealed coronary-to-PA fistulas as the cause of the high-output cardiac failure. These fistulas were successfully treated with two-stage coil embolization. Significant improvement in the patient’s Fick cardiac output, from 8.89 L/min to 6.4 L/min, and a decrease in the PA pressure, from 28/6 mm Hg to 20/11 mm Hg, indicated that the cause of the patient’s symptoms was the fistulas. The patient’s complex fistulas were also successfully treated with coiling, showcasing the advancements in percutaneous techniques. Although it is uncommon, high-output cardiac failure caused by multiple coronary-to-PA fistulas underscores the importance of considering this diagnosis when evaluating similar patients.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| 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".