Coronary steal from an anomalous circumflex artery diagnosed 25 years after ventricular septal defect closure: a case report
Bibliographic record
Abstract
Background: Association of anomalous origin of a coronary artery arising from pulmonary artery (PA) with other congenital heart defects, such as ventricular septal defects (VSDs), is uncommon. In such cases, coronary anomalies may be overlooked and underdiagnosed. Case summary: We report a case of late diagnosis of a circumflex coronary artery arising from the right PA, 25 years after VSD-closure during infancy with a complicated post-operative course with severe left ventricular dysfunction. Eventually being discharged, she remained asymptomatic until reaching adulthood, when she developed atypical chest pain during moderate exertion initially with no further investigation being performed. The patient further developed palpitations and underwent a CT-scan, showing an anomalous circumflex artery arising from the right PA. Surgical circumflex artery re-implantation was performed and the symptoms have resolved. Discussion: This case report highlights the unique pathophysiology of coronary artery steal when arising from the PA. Severe ventricular dysfunction, frequently occurring post-operatively after VSD-closure is usually related to increased afterload. However, other causes should not be neglected especially if function does not improve. Long-term follow-up is therefore mandatory for patients diagnosed with congenital heart disease, even after supposedly simple defects.
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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) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| 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".