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T1 Age 25 36 66-year-old T2 Sex 37 43 female T3 History 57 92 no significant past medical history T4 Clinical_event 93 103 presenting E1 Clinical_event:T4 T5 Sign_symptom 115 119 pain E2 Sign_symptom:T5 T6 Biological_structure 109 114 chest R1 MODIFY Arg1:T6 Arg2:E2 T7 Medication 142 150 antacids E3 Medication:T7 T8 Nonbiological_location 158 180 primary care physician R2 MODIFY Arg1:T8 Arg2:E3 T9 Clinical_event 199 208 presented E4 Clinical_event:T9 T10 Date 186 194 next day E5 Date:T10 T11 Nonbiological_location 216 230 emergency room R3 MODIFY Arg1:T11 Arg2:E4 T12 Diagnostic_procedure 241 258 electrocardiogram E6 Diagnostic_procedure:T12 T13 Disease_disorder 296 317 myocardial infarction E7 Disease_disorder:T13 T14 Detailed_description 283 295 ST elevation T15 Detailed_description 268 282 posterolateral R4 MODIFY Arg1:T14 Arg2:E7 R5 MODIFY Arg1:T15 Arg2:E7 T16 Clinical_event 347 352 taken E8 Clinical_event:T16 T17 Nonbiological_location 360 379 catheterization lab R6 MODIFY Arg1:T17 Arg2:E8 T18 Therapeutic_procedure 394 419 percutaneous intervention E9 Therapeutic_procedure:T18 T19 Sign_symptom 448 456 occluded E10 Sign_symptom:T19 T20 Severity 440 447 acutely R7 MODIFY Arg1:T20 Arg2:E10 T21 Biological_structure 457 487 large ramus intermedius vessel R8 MODIFY Arg1:T21 Arg2:E10 T22 Biological_structure 530 542 lateral wall T23 Sign_symptom 497 506 supplying E11 Sign_symptom:T23 R9 MODIFY Arg1:E11 Arg2:T21 R10 MODIFY Arg1:T22 Arg2:E11 T24 Sign_symptom 567 575 did well E12 Sign_symptom:T24 T25 Detailed_description 576 585 initially R11 MODIFY Arg1:T25 Arg2:E12 T26 Time 591 610 several hours later E13 Time:T26 T27 Disease_disorder 634 651 cardiogenic shock E14 Disease_disorder:T27 T28 Lab_value 615 623 suddenly R12 MODIFY Arg1:T28 Arg2:E14 T29 Therapeutic_procedure 656 681 intra-aortic balloon pump E15 Therapeutic_procedure:T29 T30 Diagnostic_procedure 701 715 echocardiogram E16 Diagnostic_procedure:T30 T31 Disease_disorder 749 769 mitral regurgitation E17 Disease_disorder:T31 T32 Severity 742 748 severe R13 MODIFY Arg1:T32 Arg2:E17 T33 Disease_disorder 777 785 ruptured E18 Disease_disorder:T33 T34 Biological_structure 786 802 papillary muscle R14 MODIFY Arg1:T34 Arg2:E18 T35 Therapeutic_procedure 839 846 support E19 Therapeutic_procedure:T35 T36 Lab_value 831 838 maximal R15 MODIFY Arg1:T36 Arg2:E19 T37 Sign_symptom 848 860 deteriorated E20 Sign_symptom:T37 T38 Severity 861 868 rapidly R16 MODIFY Arg1:T38 Arg2:E20 T39 Sign_symptom 886 894 acidosis E21 Sign_symptom:T39 T40 Sign_symptom 896 904 oliguria E22 Sign_symptom:T40 T41 Sign_symptom 927 932 edema E23 Sign_symptom:T41 T42 Detailed_description 910 916 florid T43 Biological_structure 917 926 pulmonary R17 MODIFY Arg1:T43 Arg2:E23 R18 MODIFY Arg1:T42 Arg2:E23 T44 Lab_value 874 885 progressive R19 MODIFY Arg1:T44 Arg2:E21 A1 TREND E21 INC T45 Diagnostic_procedure 1046 1062 echocardiography E24 Diagnostic_procedure:T45 T46 Biological_structure 1030 1045 transesophageal R20 MODIFY Arg1:T46 Arg2:E24 T47 Disease_disorder 1080 1100 mitral regurgitation E25 Disease_disorder:T47 T48 Severity 1073 1079 severe R21 MODIFY Arg1:T48 Arg2:E25 T49 Disease_disorder 1108 1116 ruptured E26 Disease_disorder:T49 T50 Biological_structure 1117 1147 anterolateral papillary muscle R22 MODIFY Arg1:T50 Arg2:E26 T51 Sign_symptom 1154 1159 small E27 Sign_symptom:T51 T52 Biological_structure 1160 1171 left atrium R23 MODIFY Arg1:T52 Arg2:E27 T53 Therapeutic_procedure 1210 1232 cardiopulmonary bypass E28 Therapeutic_procedure:T53 T54 Sign_symptom 1238 1246 acidosis E29 Sign_symptom:T54 A2 POLARITY E29 NEG T55 Clinical_event 1273 1283 make urine E30 Clinical_event:T55 T56 Diagnostic_procedure 1295 1308 visualization E31 Diagnostic_procedure:T56 T57 Biological_structure 1316 1328 mitral valve R24 MODIFY Arg1:T57 Arg2:E31 T58 Detailed_description 1350 1379 vertical transseptal approach R25 MODIFY Arg1:T58 Arg2:E31 T59 Biological_structure 1392 1404 right atrium R26 MODIFY Arg1:T59 Arg2:T58 T60 Diagnostic_procedure 1430 1439 inspected E32 Diagnostic_procedure:T60 T61 Coreference 1410 1415 valve E33 Coreference:T61 R27 IDENTICAL Arg1:E33 Arg2:T57 R28 MODIFY Arg1:E33 Arg2:E32 T63 Sign_symptom 1448 1456 necrotic E35 Sign_symptom:T63 T64 Disease_disorder 1457 1465 ruptured E36 Disease_disorder:T64 T65 Biological_structure 1466 1496 anterolateral papillary muscle R29 MODIFY Arg1:T65 Arg2:E36 R30 MODIFY Arg1:T65 Arg2:E35 T62 Sign_symptom 1552 1560 attached E34 Sign_symptom:T62 T66 Biological_structure 1568 1588 A1 chordal apparatus T67 Biological_structure 1536 1551 chunk of muscle R31 MODIFY Arg1:T67 Arg2:E34 R32 MODIFY Arg1:T66 Arg2:E34 T68 Severity 1530 1535 large R33 MODIFY Arg1:T68 Arg2:T67 T69 Therapeutic_procedure 1635 1642 excised E37 Therapeutic_procedure:T69 T70 Biological_structure 1594 1630 anterior leaflet of the mitral valve R34 MODIFY Arg1:T70 Arg2:E37 T71 Sign_symptom 1679 1685 intact E38 Sign_symptom:T71 T72 Biological_structure 1661 1678 posterior leaflet R35 MODIFY Arg1:T72 Arg2:E38 T73 Therapeutic_procedure 1708 1721 bioprosthesis E39 Therapeutic_procedure:T73 T74 Detailed_description 1695 1707 St Jude Epic R36 MODIFY Arg1:T74 Arg2:E39 T75 Distance 1689 1694 27-mm R37 MODIFY Arg1:T75 Arg2:E39 T76 Therapeutic_procedure 1765 1800 extracorporeal membrane oxygenation E40 Therapeutic_procedure:T76 T77 Therapeutic_procedure 1823 1829 weaned E41 Therapeutic_procedure:T77 T78 Date 1830 1842 3 days later E42 Date:T78 #1 AnnotatorNotes E41 from extracorporeal membrane oxygenation T79 Sign_symptom 1888 1896 recovery E43 Sign_symptom:T79 T80 Lab_value 1882 1887 early R38 MODIFY Arg1:T80 Arg2:E43 T81 Date 1898 1913 One month later E44 Date:T81 T82 Clinical_event 1929 1938 discharge E45 Clinical_event:T82 A3 POLARITY E45 NEG T83 Outcome 1944 1951 expired E46 Outcome:T83 T84 Disease_disorder 1969 1978 pneumonia E47 Disease_disorder:T84 T85 Disease_disorder 1998 2004 sepsis E48 Disease_disorder:T85 T86 Disease_disorder 2010 2028 multiorgan failure E49 Disease_disorder:T86 * OVERLAP E1 E2 R39 BEFORE Arg1:E2 Arg2:E3 R40 BEFORE Arg1:E3 Arg2:E5 * OVERLAP E5 E4 E6 E7 R41 BEFORE Arg1:E7 Arg2:E8 * OVERLAP E8 E9 E10 E11 R42 BEFORE Arg1:E11 Arg2:E12 R43 BEFORE Arg1:E12 Arg2:E13 * OVERLAP E13 E14 R44 BEFORE Arg1:E14 Arg2:E15 * OVERLAP E15 E16 E17 E18 R45 BEFORE Arg1:E18 Arg2:E19 * OVERLAP E19 E20 E21 E22 E23 R46 BEFORE Arg1:E23 Arg2:E24 T87 Nonbiological_location 1014 1028 operating room R47 MODIFY Arg1:T87 Arg2:E24 * OVERLAP E24 E25 E26 E27 R48 BEFORE Arg1:E27 Arg2:E28 R49 AFTER Arg1:E28 Arg2:E29 * OVERLAP E29 E30 R50 BEFORE Arg1:E30 Arg2:E31 * OVERLAP E31 E33 E32 E35 E36 E34 R51 BEFORE Arg1:E34 Arg2:E37 * OVERLAP E37 E38 E39 R52 BEFORE Arg1:E39 Arg2:E40 R53 BEFORE Arg1:E40 Arg2:E41 * OVERLAP E41 E42 R54 BEFORE Arg1:E42 Arg2:E43 R55 BEFORE Arg1:E43 Arg2:E44 * OVERLAP E44 E45 E46 E47 E48 E49