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T1 Age 20 31 77-year-old T2 Sex 32 35 man T3 Date 3 16 February 2010 E1 Date:T3 T4 Disease_disorder 54 60 stroke E2 Disease_disorder:T4 T5 Disease_disorder 65 92 peripheral vascular disease E3 Disease_disorder:T5 T6 History 54 60 stroke T7 History 65 92 peripheral vascular disease T8 Clinical_event 93 102 presented E4 Clinical_event:T8 T9 Nonbiological_location 110 130 emergency department R1 MODIFY Arg1:T9 Arg2:E4 T10 Disease_disorder 141 156 pulmonary edema E5 Disease_disorder:T10 T11 Detailed_description 134 140 florid R2 MODIFY Arg1:T11 Arg2:E5 T12 History 186 215 worsening dyspnea on exertion T13 Duration 167 182 6-month history E6 Duration:T13 T14 Sign_symptom 196 203 dyspnea E7 Sign_symptom:T14 T15 Activity 207 215 exertion E8 Activity:T15 A1 TREND E7 INC R3 CAUSE Arg1:E8 Arg2:E7 T16 Sign_symptom 238 245 dyspnea E9 Sign_symptom:T16 T17 Detailed_description 228 237 nocturnal T18 Detailed_description 217 227 paroxysmal R4 MODIFY Arg1:T17 Arg2:E9 R5 MODIFY Arg1:T18 Arg2:E9 T19 Sign_symptom 255 260 edema E10 Sign_symptom:T19 T20 Biological_structure 251 254 leg R6 MODIFY Arg1:T20 Arg2:E10 T21 History 217 245 paroxysmal nocturnal dyspnea T22 History 251 260 leg edema T23 Diagnostic_procedure 267 287 physical examination E11 Diagnostic_procedure:T23 T24 Sign_symptom 304 309 rales E12 Sign_symptom:T24 T25 Sign_symptom 316 341 murmur of aortic stenosis E13 Sign_symptom:T25 T26 Detailed_description 296 303 diffuse R7 MODIFY Arg1:T26 Arg2:E12 T27 Diagnostic_procedure 381 395 echocardiogram E14 Diagnostic_procedure:T27 T28 Biological_structure 367 380 transthoracic R8 MODIFY Arg1:T28 Arg2:E14 T29 Detailed_description 345 366 2-dimensional Doppler R9 MODIFY Arg1:T29 Arg2:E14 T30 Disease_disorder 412 433 aortic valve stenosis E15 Disease_disorder:T30 T31 Severity 405 411 severe R10 MODIFY Arg1:T31 Arg2:E15 T32 Diagnostic_procedure 441 454 peak gradient E16 Diagnostic_procedure:T32 T33 Lab_value 458 465 70 mmHg E17 Lab_value:T33 R11 MODIFY Arg1:E17 Arg2:E16 T34 Diagnostic_procedure 472 485 mean gradient E18 Diagnostic_procedure:T34 T35 Lab_value 489 496 45 mmHg E19 Lab_value:T35 R12 MODIFY Arg1:E19 Arg2:E18 T36 Diagnostic_procedure 500 528 calculated aortic valve area E20 Diagnostic_procedure:T36 T37 Lab_value 532 539 0.7 cm2 E21 Lab_value:T37 R13 MODIFY Arg1:E21 Arg2:E20 T38 Disease_disorder 548 568 mitral regurgitation E22 Disease_disorder:T38 T39 Severity 541 547 severe R14 MODIFY Arg1:T39 Arg2:E22 T40 Sign_symptom 585 592 dilated E23 Sign_symptom:T40 T41 Severity 576 584 severely R15 MODIFY Arg1:T41 Arg2:E23 T42 Biological_structure 593 607 left ventricle R16 MODIFY Arg1:T42 Arg2:E23 T43 Biological_structure 609 611 LV R17 IDENTICAL Arg1:T43 Arg2:T42 T44 Diagnostic_procedure 621 638 ejection fraction E24 Diagnostic_procedure:T44 T45 Lab_value 642 646 0.20 E25 Lab_value:T45 R18 MODIFY Arg1:E25 Arg2:E24 T46 Disease_disorder 658 673 pulmonary edema E26 Disease_disorder:T46 A2 POLARITY E26 NEG T47 Diagnostic_procedure 688 711 cardiac catheterization E27 Diagnostic_procedure:T47 T48 Coreference 726 752 echocardiographic findings E28 Coreference:T48 R19 SUB_PROCEDURE Arg1:E28 Arg2:E14 R20 SUB_PROCEDURE Arg1:E16 Arg2:E14 R21 SUB_PROCEDURE Arg1:E18 Arg2:E14 R22 SUB_PROCEDURE Arg1:E20 Arg2:E14 T49 Disease_disorder 779 802 coronary artery disease E29 Disease_disorder:T49 T50 Detailed_description 764 778 nonobstructive R23 MODIFY Arg1:T50 Arg2:E29 T51 Therapeutic_procedure 893 910 surgical approach E30 Therapeutic_procedure:T51 T52 Detailed_description 874 892 minimally invasive R24 MODIFY Arg1:T52 Arg2:E30 T53 Therapeutic_procedure 942 957 supine position E31 Therapeutic_procedure:T53 T54 Medication 972 982 anesthetic E32 Medication:T54 T55 Therapeutic_procedure 997 1007 intubation E33 Therapeutic_procedure:T55 T56 Detailed_description 1015 1045 single-lumen endotracheal tube R25 MODIFY Arg1:T56 Arg2:E33 T57 Detailed_description 1052 1069 bronchial blocker R26 MODIFY Arg1:T57 Arg2:E33 T58 Diagnostic_procedure 1086 1118 transesophageal echocardiography E34 Diagnostic_procedure:T58 T59 Diagnostic_procedure 1120 1123 TEE E35 Diagnostic_procedure:T59 R27 IDENTICAL Arg1:E35 Arg2:E34 T60 Disease_disorder 1215 1234 significant disease E36 Disease_disorder:T60 A3 POLARITY E36 NEG T61 Biological_structure 1180 1201 mitral valve leaflets R28 MODIFY Arg1:T61 Arg2:E36 T62 Disease_disorder 1248 1268 mitral regurgitation E37 Disease_disorder:T62 T63 Biological_structure 1308 1320 mitral valve T64 Biological_structure 1287 1300 A2–P2 portion R29 MODIFY Arg1:T64 Arg2:T63 R30 MODIFY Arg1:T63 Arg2:E37 T65 Disease_disorder 1334 1354 mitral regurgitation E38 Disease_disorder:T65 T66 Detailed_description 1373 1383 functional R31 MODIFY Arg1:T66 Arg2:E38 T67 Sign_symptom 1395 1418 mitral annular dilation E39 Sign_symptom:T67 T68 Sign_symptom 1423 1432 tethering E40 Sign_symptom:T68 T69 Biological_structure 1440 1457 papillary muscles R32 MODIFY Arg1:T69 Arg2:E40 T70 Sign_symptom 1474 1481 dilated E41 Sign_symptom:T70 T71 Severity 1465 1473 severely R33 MODIFY Arg1:T71 Arg2:E41 T72 Biological_structure 1482 1484 LV R34 MODIFY Arg1:T72 Arg2:E41 R35 CAUSE Arg1:E41 Arg2:E40 R36 CAUSE Arg1:E40 Arg2:E38 R37 CAUSE Arg1:E39 Arg2:E38 T73 Therapeutic_procedure 1521 1527 repair E42 Therapeutic_procedure:T73 T74 Biological_structure 1535 1547 mitral valve R38 MODIFY Arg1:T74 Arg2:E42 T75 Detailed_description 1555 1575 transaortic approach R39 MODIFY Arg1:T75 Arg2:E42 T76 Therapeutic_procedure 1618 1640 cardiopulmonary bypass E43 Therapeutic_procedure:T76 T77 Therapeutic_procedure 1579 1595 femoral platform E44 Therapeutic_procedure:T77 R40 SUB_PROCEDURE Arg1:E44 Arg2:E43 T78 Therapeutic_procedure 1655 1663 incision E45 Therapeutic_procedure:T78 T79 Distance 1644 1654 2- to 3-cm R41 MODIFY Arg1:T79 Arg2:E45 T80 Biological_structure 1680 1700 left inguinal crease R42 MODIFY Arg1:T80 Arg2:E45 T81 Therapeutic_procedure 1729 1735 suture E46 Therapeutic_procedure:T81 T82 Detailed_description 1704 1728 5–0 Prolene purse-string R43 MODIFY Arg1:T82 Arg2:E46 T84 Detailed_description 1737 1794 Ethicon Inc., a Johnson & Johnson company; Somerville, NJ R45 MODIFY Arg1:T84 Arg2:E46 T85 Biological_structure 1814 1837 femoral artery and vein R46 MODIFY Arg1:T85 Arg2:E46 T86 Therapeutic_procedure 1867 1877 cannulated E47 Therapeutic_procedure:T86 T87 Biological_structure 1843 1862 left femoral artery R47 MODIFY Arg1:T87 Arg2:E47 T88 Detailed_description 1885 1909 16F–18F arterial cannula R48 MODIFY Arg1:T88 Arg2:E47 T89 Therapeutic_procedure 1937 1947 cannulated E48 Therapeutic_procedure:T89 T90 Biological_structure 1915 1932 left femoral vein R49 MODIFY Arg1:T90 Arg2:E48 T91 Detailed_description 1996 2030 Medtronic, Inc.; Minneapolis, Minn R50 MODIFY Arg1:T91 Arg2:E48 T92 Detailed_description 1955 1994 25F Bio-Medicus® femoral venous cannula R51 MODIFY Arg1:T92 Arg2:E48 T83 Biological_structure 2057 2075 superior vena cava R44 MODIFY Arg1:T83 Arg2:E48 T93 Diagnostic_procedure 2092 2095 TEE E49 Diagnostic_procedure:T93 T94 Therapeutic_procedure 2146 2154 incision E50 Therapeutic_procedure:T94 T95 Detailed_description 2123 2145 transverse parasternal R52 MODIFY Arg1:T95 Arg2:E50 T96 Distance 2112 2122 4- to 5-cm R53 MODIFY Arg1:T96 Arg2:E50 T97 Biological_structure 2164 2185 3rd intercostal space R54 MODIFY Arg1:T97 Arg2:E50 T98 Biological_structure 2205 2232 4th costochondral cartilage R55 MODIFY Arg1:T98 Arg2:E50 T99 Therapeutic_procedure 2252 2260 exposure E51 Therapeutic_procedure:T99 R56 SUB_PROCEDURE Arg1:E50 Arg2:E51 T100 Biological_structure 2268 2273 aorta R57 MODIFY Arg1:T100 Arg2:E51 T101 Therapeutic_procedure 2378 2384 opened E52 Therapeutic_procedure:T101 T102 Biological_structure 2362 2373 pericardium R58 MODIFY Arg1:T102 Arg2:E52 T103 Biological_structure 2385 2408 above the phrenic nerve T104 Biological_structure 2413 2427 over the aorta T105 Therapeutic_procedure 2442 2450 exposure E53 Therapeutic_procedure:T105 R59 SUB_PROCEDURE Arg1:E52 Arg2:E53 R60 MODIFY Arg1:T103 Arg2:E52 R61 MODIFY Arg1:T104 Arg2:E52 T106 Therapeutic_procedure 2480 2488 catheter E54 Therapeutic_procedure:T106 T107 Biological_structure 2465 2479 coronary sinus R62 MODIFY Arg1:T107 Arg2:E54 T108 Detailed_description 2454 2464 retrograde R63 MODIFY Arg1:T108 Arg2:E54 T109 Therapeutic_procedure 2523 2531 incision E55 Therapeutic_procedure:T109 T110 Therapeutic_procedure 2552 2558 suture E56 Therapeutic_procedure:T110 T111 Detailed_description 2539 2551 purse-string R64 MODIFY Arg1:T111 Arg2:E56 T112 Biological_structure 2577 2589 right atrium R65 MODIFY Arg1:T112 Arg2:E56 T113 Therapeutic_procedure 2596 2600 vent E57 Therapeutic_procedure:T113 T114 Therapeutic_procedure 2633 2639 suture E58 Therapeutic_procedure:T114 T115 Detailed_description 2620 2632 purse-string R66 MODIFY Arg1:T115 Arg2:E58 T116 Biological_structure 2593 2595 LV R67 MODIFY Arg1:T116 Arg2:E57 T117 Biological_structure 2647 2676 right superior pulmonary vein R68 MODIFY Arg1:T117 Arg2:E58 T118 Therapeutic_procedure 2691 2700 aortotomy E59 Therapeutic_procedure:T118 T119 Detailed_description 2680 2690 transverse R69 MODIFY Arg1:T119 Arg2:E59 T120 Therapeutic_procedure 2718 2724 expose E60 Therapeutic_procedure:T120 R70 SUB_PROCEDURE Arg1:E59 Arg2:E60 T121 Biological_structure 2729 2741 aortic valve R71 MODIFY Arg1:T121 Arg2:E60 T122 Therapeutic_procedure 2753 2760 removed E61 Therapeutic_procedure:T122 T123 Diagnostic_procedure 2767 2780 direct vision E62 Diagnostic_procedure:T123 R72 MODIFY Arg1:T121 Arg2:E61 T124 Sign_symptom 3944 3956 asymptomatic E63 Sign_symptom:T124 T125 Diagnostic_procedure 3962 3978 echocardiography E64 Diagnostic_procedure:T125 T126 Clinical_event 3901 3910 follow-up E65 Clinical_event:T126 T127 Date 3925 3935 March 2011 E66 Date:T127 T128 Disease_disorder 3995 4015 mitral regurgitation E67 Disease_disorder:T128 T129 Lab_value 3986 3994 grade 1+ E68 Lab_value:T129 R73 MODIFY Arg1:E68 Arg2:E67 T130 Sign_symptom 3802 3821 shortness of breath E69 Sign_symptom:T130 A4 POLARITY E69 NEG T131 Sign_symptom 3788 3796 did well E70 Sign_symptom:T131 T132 Clinical_event 3843 3853 discharged E71 Clinical_event:T132 T133 Nonbiological_location 3863 3871 hospital R74 MODIFY Arg1:T133 Arg2:E71 T134 Date 3875 3894 postoperative day 6 E72 Date:T134 T135 Diagnostic_procedure 2830 2840 identified E73 Diagnostic_procedure:T135 T136 Biological_structure 2812 2824 mitral valve T137 Biological_structure 2786 2804 A2 and P2 segments R75 MODIFY Arg1:T137 Arg2:T136 R76 MODIFY Arg1:T136 Arg2:E73 T138 Therapeutic_procedure 2862 2868 repair E74 Therapeutic_procedure:T138 T139 Detailed_description 2849 2861 edge-to-edge R77 MODIFY Arg1:T139 Arg2:E74 T140 Detailed_description 1508 1520 edge-to-edge R78 MODIFY Arg1:T140 Arg2:E42 T141 Therapeutic_procedure 2913 2919 suture E75 Therapeutic_procedure:T141 T142 Detailed_description 2892 2912 5–0 Prolene mattress R79 MODIFY Arg1:T142 Arg2:E75 T143 Detailed_description 2929 2965 reinforced with pericardial pledgets R80 MODIFY Arg1:T143 Arg2:E75 T144 Biological_structure 2997 3009 mitral valve R81 MODIFY Arg1:T144 Arg2:E75 T145 Biological_structure 2973 2989 ventricular side R82 MODIFY Arg1:T145 Arg2:T144 R83 SUB_PROCEDURE Arg1:E75 Arg2:E74 T146 Therapeutic_procedure 3045 3071 bioprosthetic aortic valve E76 Therapeutic_procedure:T146 T147 Detailed_description 3073 3082 Medtronic R84 MODIFY Arg1:T147 Arg2:E76 T148 Detailed_description 3027 3044 27-mm Hancock® II R85 MODIFY Arg1:T148 Arg2:E76 T149 Detailed_description 3108 3127 standard techniques R86 MODIFY Arg1:T149 Arg2:E78 T150 Therapeutic_procedure 3133 3142 aortotomy E77 Therapeutic_procedure:T150 T151 Therapeutic_procedure 3088 3097 implanted E78 Therapeutic_procedure:T151 R87 SUB_PROCEDURE Arg1:E78 Arg2:E76 T152 Therapeutic_procedure 3147 3153 closed E79 Therapeutic_procedure:T152 R88 SUB_PROCEDURE Arg1:E79 Arg2:E77 T153 Detailed_description 3157 3172 2-layer fashion R89 MODIFY Arg1:T153 Arg2:E79 T154 Therapeutic_procedure 3206 3228 cardiopulmonary bypass E80 Therapeutic_procedure:T154 A5 POLARITY E80 NEG T155 Therapeutic_procedure 3253 3263 reattached E81 Therapeutic_procedure:T155 T156 Biological_structure 3245 3248 rib R90 MODIFY Arg1:T156 Arg2:E81 T157 Biological_structure 3271 3278 sternum R91 MODIFY Arg1:T157 Arg2:E81 T158 Detailed_description 3286 3302 1-cm metal plate T159 Detailed_description 3304 3335 Synthes, Inc.; West Chester, Pa R92 MODIFY Arg1:T158 Arg2:E81 R93 MODIFY Arg1:T159 Arg2:E81 T160 Therapeutic_procedure 3442 3453 thoracotomy E82 Therapeutic_procedure:T160 T161 Therapeutic_procedure 3458 3464 closed E83 Therapeutic_procedure:T161 R94 SUB_PROCEDURE Arg1:E83 Arg2:E82 T162 Detailed_description 3468 3483 routine fashion R95 MODIFY Arg1:T162 Arg2:E83 T163 Therapeutic_procedure 3359 3365 placed E84 Therapeutic_procedure:T163 T164 Detailed_description 3344 3354 fiber wire R96 MODIFY Arg1:T164 Arg2:E84 R97 SUB_PROCEDURE Arg1:E84 Arg2:E81 T165 Detailed_description 3369 3385 figure-8 fashion R98 MODIFY Arg1:T165 Arg2:E84 T166 Therapeutic_procedure 3411 3415 left E85 Therapeutic_procedure:T166 T167 Biological_structure 3423 3436 pleural space R99 MODIFY Arg1:T167 Arg2:E85 T168 Detailed_description 3396 3406 chest tube R100 MODIFY Arg1:T168 Arg2:E85 T169 Quantitative_concept 3389 3395 single R101 MODIFY Arg1:T169 Arg2:T168 T170 Disease_disorder 3513 3533 mitral regurgitation E86 Disease_disorder:T170 A6 POLARITY E86 NEG T171 Diagnostic_procedure 3499 3502 TEE E87 Diagnostic_procedure:T171 T172 Therapeutic_procedure 3767 3774 surgery E88 Therapeutic_procedure:T172 T173 Therapeutic_procedure 3745 3751 repair E89 Therapeutic_procedure:T173 T174 Detailed_description 3732 3744 edge-to-edge R102 MODIFY Arg1:T174 Arg2:E89 T175 Sign_symptom 3681 3695 double-orifice E90 Sign_symptom:T175 T176 Biological_structure 3696 3708 mitral valve R103 MODIFY Arg1:T176 Arg2:E90 T177 Sign_symptom 3544 3552 elbowing E91 Sign_symptom:T177 T178 Biological_structure 3561 3577 anterior leaflet R104 MODIFY Arg1:T178 Arg2:E91 T179 Sign_symptom 3605 3614 tethering E92 Sign_symptom:T179 T180 Biological_structure 3622 3638 anterior leaflet T181 Biological_structure 3646 3663 posterior leaflet R105 CAUSE Arg1:E89 Arg2:E90 R106 MODIFY Arg1:T181 Arg2:E92 R107 MODIFY Arg1:T180 Arg2:E92 R108 CAUSE Arg1:E92 Arg2:E91 R109 AFTER Arg1:E1 Arg2:E2 * OVERLAP E2 E3 R110 BEFORE Arg1:E3 Arg2:E4 * OVERLAP E4 E5 R111 AFTER Arg1:E5 Arg2:E6 * OVERLAP E6 E7 E8 E9 E10 R112 BEFORE Arg1:E10 Arg2:E11 * OVERLAP E11 E12 E13 E14 E15 E22 E23 E24 R113 BEFORE Arg1:E24 Arg2:E26 R114 BEFORE Arg1:E26 Arg2:E27 * OVERLAP E27 E28 E29 R115 BEFORE Arg1:E29 Arg2:E30 R116 SUB_PROCEDURE Arg1:E31 Arg2:E30 R117 SUB_PROCEDURE Arg1:E33 Arg2:E30 R118 SUB_PROCEDURE Arg1:E32 Arg2:E30 * OVERLAP E30 E34 E36 E37 E38 E39 E40 E41 E42 R119 SUB_PROCEDURE Arg1:E44 Arg2:E42 R120 SUB_PROCEDURE Arg1:E45 Arg2:E42 R121 SUB_PROCEDURE Arg1:E46 Arg2:E42 R122 SUB_PROCEDURE Arg1:E47 Arg2:E42 R123 SUB_PROCEDURE Arg1:E48 Arg2:E42 R124 SUB_PROCEDURE Arg1:E51 Arg2:E42 R125 SUB_PROCEDURE Arg1:E53 Arg2:E42 R126 SUB_PROCEDURE Arg1:E55 Arg2:E54 R127 SUB_PROCEDURE Arg1:E54 Arg2:E42 R128 SUB_PROCEDURE Arg1:E56 Arg2:E42 R129 SUB_PROCEDURE Arg1:E57 Arg2:E42 R130 SUB_PROCEDURE Arg1:E58 Arg2:E42 R131 SUB_PROCEDURE Arg1:E60 Arg2:E42 R132 SUB_PROCEDURE Arg1:E61 Arg2:E42 R133 SUB_PROCEDURE Arg1:E49 Arg2:E42 R134 SUB_PROCEDURE Arg1:E62 Arg2:E61 R135 SUB_PROCEDURE Arg1:E73 Arg2:E42 R136 IDENTICAL Arg1:E74 Arg2:E42 R137 BEFORE Arg1:E42 Arg2:E76 * OVERLAP E76 E77 R138 BEFORE Arg1:E77 Arg2:E80 R139 BEFORE Arg1:E80 Arg2:E81 * OVERLAP E81 E85 R140 AFTER Arg1:E85 Arg2:E82 R141 BEFORE Arg1:E82 Arg2:E87 * OVERLAP E87 E86 E91 E90 R142 AFTER Arg1:E90 Arg2:E88 R143 BEFORE Arg1:E88 Arg2:E70 * OVERLAP E70 E69 R144 BEFORE Arg1:E69 Arg2:E71 * OVERLAP E71 E72 R145 BEFORE Arg1:E72 Arg2:E65 * OVERLAP E65 E66 E63 E64 E67