Establishing an Anatomical Proximity Between the Coronary Circumflex Artery and the Mitral Valve Annulus: Implications for Mitral Valve Surgery
Bibliographic record
Abstract
The coronary circumflex artery (CX) lies in the left atrioventricular groove, running intimately parallel to the mitral valve annulus. Thus, unintentional damage to the CX can occur via a fixation suture during mitral valve surgery, typically reported in hearts with a left dominant or co‐dominant circulation. This study aims to elucidate the anatomical relationship between the CX and annulus, and evaluate damage to the CX following three different mitral valve surgical repairs. It is predicted that left dominant or co‐dominant hearts should exhibit the closest anatomical relationship between the CX and annulus and experience a greater incidence of damage despite the chosen mitral valve surgery. Using fixed (n=18) and fresh‐frozen (n=9) cadaveric hearts, coronary circulation was dissected and dominance determined. After opening the left atrial wall, a clock face was overlaid on the mitral valve (12:00 position at the A2 leaflet midline) and the distance between the annulus and the CX was measured at each hour. The CX was closest to the annulus in fresh‐frozen, left dominant hearts. All left dominant and co‐dominant hearts had CXs that hugged the posterior length of the annulus, diving deep at 3:00 (before the posterior commissure), a finding previously unreported. Preliminary results from the ongoing surgical repairs advocate for cautionary suture placement in areas formerly considered to be at low risk for damage.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".