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T1 Age 0 13 A 49-year-old T2 Sex 14 17 man T3 History 24 53 no history of cardiac disease T4 Sign_symptom 82 89 dyspnea E1 Sign_symptom:T4 T5 Detailed_description 70 81 progressive R1 MODIFY Arg1:T5 Arg2:E1 T6 Duration 93 113 one month's duration E2 Duration:T6 T7 History 161 248 blunt chest trauma, the result of an accidental fall from scaffolding 15 months earlier T8 Disease_disorder 173 179 trauma E3 Disease_disorder:T8 T9 Biological_structure 167 172 chest T10 Detailed_description 161 166 blunt R2 MODIFY Arg1:T9 Arg2:E3 R3 MODIFY Arg1:T10 Arg2:E3 T11 Date 231 248 15 months earlier E4 Date:T11 T12 Activity 198 213 accidental fall E5 Activity:T12 R4 CAUSE Arg1:E5 Arg2:E3 T13 Sign_symptom 393 405 pneumothorax E6 Sign_symptom:T13 T14 Detailed_description 383 392 bilateral R5 MODIFY Arg1:T14 Arg2:E6 T15 Sign_symptom 430 438 hematoma E7 Sign_symptom:T15 T16 Biological_structure 407 429 right iliopsoas muscle R6 MODIFY Arg1:T16 Arg2:E7 T17 Sign_symptom 462 471 fractures E8 Sign_symptom:T17 T18 Biological_structure 449 461 right costal T19 Detailed_description 440 448 multiple R7 MODIFY Arg1:T18 Arg2:E8 R8 MODIFY Arg1:T19 Arg2:E8 T20 Sign_symptom 473 481 fracture E9 Sign_symptom:T20 T21 Biological_structure 489 506 L3 vertebral body R9 MODIFY Arg1:T21 Arg2:E9 T22 Biological_structure 515 533 transverse process R10 MODIFY Arg1:T22 Arg2:E9 T23 Sign_symptom 549 558 fractures E10 Sign_symptom:T23 T24 Biological_structure 566 580 right clavicle R11 MODIFY Arg1:T24 Arg2:E10 T25 Detailed_description 539 548 displaced R12 MODIFY Arg1:T25 Arg2:E10 T26 Clinical_event 587 602 hospitalization E11 Clinical_event:T26 T27 Duration 614 621 40 days E12 Duration:T27 T28 Sign_symptom 677 683 murmur E13 Sign_symptom:T28 A1 POLARITY E13 NEG T29 Diagnostic_procedure 699 717 cardiac evaluation E14 Diagnostic_procedure:T29 A2 POLARITY E14 NEG T30 Activity 743 760 normal activities E15 Activity:T30 T31 Date 761 774 4 weeks after E16 Date:T31 T32 Clinical_event 775 784 discharge E17 Clinical_event:T32 T33 Nonbiological_location 794 802 hospital R13 MODIFY Arg1:T33 Arg2:E17 T34 Sign_symptom 816 828 asymptomatic E18 Sign_symptom:T34 T35 Clinical_event 852 859 arrival E19 Clinical_event:T35 T36 Nonbiological_location 867 877 department R14 MODIFY Arg1:T36 Arg2:E19 T37 Diagnostic_procedure 879 891 auscultation E20 Diagnostic_procedure:T37 T38 Sign_symptom 911 916 rales E21 Sign_symptom:T38 T39 Sign_symptom 935 941 murmur E22 Sign_symptom:T39 T40 Detailed_description 923 934 pansystolic T41 Detailed_description 901 910 bibasilar R15 MODIFY Arg1:T40 Arg2:E22 R16 MODIFY Arg1:T41 Arg2:E21 T42 Diagnostic_procedure 949 960 radiography E23 Diagnostic_procedure:T42 T43 Biological_structure 943 948 Chest R17 MODIFY Arg1:T43 Arg2:E23 T44 Sign_symptom 978 988 congestion E24 Sign_symptom:T44 T45 Biological_structure 973 977 lung T46 Severity 968 972 mild R18 MODIFY Arg1:T45 Arg2:E24 R19 MODIFY Arg1:T46 Arg2:E24 T47 Diagnostic_procedure 1008 1024 echocardiography E25 Diagnostic_procedure:T47 T48 Biological_structure 994 1007 transthoracic R20 MODIFY Arg1:T48 Arg2:E25 T49 Sign_symptom 1093 1113 mitral regurgitation E26 Sign_symptom:T49 T50 Detailed_description 1083 1092 eccentric T51 Severity 1075 1081 severe R21 MODIFY Arg1:T50 Arg2:E26 R22 MODIFY Arg1:T51 Arg2:E26 T52 Detailed_description 1026 1064 limited by suboptimal acoustic windows R23 MODIFY Arg1:T52 Arg2:E25 T53 Sign_symptom 1226 1233 dilated E27 Sign_symptom:T53 T54 Biological_structure 1198 1209 left atrium T55 Severity 1219 1225 mildly R24 MODIFY Arg1:T55 Arg2:E27 R25 MODIFY Arg1:T54 Arg2:E27 T56 Sign_symptom 1169 1188 structurally normal E28 Sign_symptom:T56 T57 Biological_structure 1119 1127 valvular T58 Biological_structure 1132 1153 subvalvular apparatus R26 MODIFY Arg1:T58 Arg2:E28 R27 MODIFY Arg1:T57 Arg2:E28 T59 Medication 1276 1285 diuretics E29 Medication:T59 T60 Administration 1264 1275 intravenous R28 MODIFY Arg1:T60 Arg2:E29 T61 Sign_symptom 1296 1328 signs and symptoms of congestion E30 Sign_symptom:T61 A3 POLARITY E30 NEG T62 Diagnostic_procedure 1353 1364 angiography E31 Diagnostic_procedure:T62 T63 Biological_structure 1344 1352 Coronary R29 MODIFY Arg1:T63 Arg2:E31 T64 Disease_disorder 1400 1416 coronary disease E32 Disease_disorder:T64 A4 POLARITY E32 NEG T65 Therapeutic_procedure 1474 1493 mitral valve repair E33 Therapeutic_procedure:T65 T66 History 250 355 He had fallen approximately 8 feet and had landed on the right side of his back and on his right shoulder T67 Diagnostic_procedure 1537 1569 transesophageal echocardiography E34 Diagnostic_procedure:T67 T68 Diagnostic_procedure 1571 1574 TEE E35 Diagnostic_procedure:T68 R30 IDENTICAL Arg1:E35 Arg2:E34 T69 Detailed_description 1522 1536 intraoperative R31 MODIFY Arg1:T69 Arg2:E34 T70 Sign_symptom 1612 1634 mitral regurgitant jet E36 Sign_symptom:T70 T71 Sign_symptom 1648 1676 perivalvular regurgitant jet E37 Sign_symptom:T71 T72 Severity 1641 1647 severe T73 Severity 1596 1603 trivial T74 Detailed_description 1604 1611 central R32 MODIFY Arg1:T74 Arg2:E36 R33 MODIFY Arg1:T73 Arg2:E36 R34 MODIFY Arg1:T72 Arg2:E37 T75 Sign_symptom 1724 1747 fistulous communication E38 Sign_symptom:T75 T76 Biological_structure 1707 1723 ventriculoatrial T77 Biological_structure 1748 1769 behind the P1 scallop R35 MODIFY Arg1:T77 Arg2:E38 R36 MODIFY Arg1:T76 Arg2:E38 R37 CAUSE Arg1:E38 Arg2:E37 T78 Disease_disorder 1824 1842 structural disease E39 Disease_disorder:T78 A5 POLARITY E39 NEG T79 Biological_structure 1857 1872 mitral leaflets T80 Biological_structure 1876 1897 subvalvular apparatus R38 MODIFY Arg1:T79 Arg2:E39 R39 MODIFY Arg1:T80 Arg2:E39 T81 Therapeutic_procedure 1905 1922 surgical exposure E40 Therapeutic_procedure:T81 T82 Biological_structure 1930 1942 mitral valve R40 MODIFY Arg1:T82 Arg2:E40 T83 Sign_symptom 1952 1956 tear E41 Sign_symptom:T83 T84 Lab_value 1946 1951 small T85 Distance 1958 1972 length, 6–7 mm R41 MODIFY Arg1:T85 Arg2:E41 R42 MODIFY Arg1:T84 Arg2:E41 T86 Biological_structure 1988 2016 behind the posterior leaflet R43 MODIFY Arg1:T86 Arg2:E41 T87 Detailed_description 2023 2039 lateral position R44 MODIFY Arg1:T87 Arg2:E41 T88 Biological_structure 2060 2067 annulus T89 Biological_structure 2076 2092 left atrial wall R45 MODIFY Arg1:T88 Arg2:E41 R46 MODIFY Arg1:T89 Arg2:E41 T90 Sign_symptom 2188 2205 perivalvular leak E42 Sign_symptom:T90 T91 Sign_symptom 2117 2130 abnormalities E43 Sign_symptom:T91 A6 POLARITY E43 NEG T92 Sign_symptom 2134 2145 vegetations E44 Sign_symptom:T92 A7 POLARITY E44 NEG T93 Biological_structure 2109 2116 leaflet R47 MODIFY Arg1:T93 Arg2:E43 R48 MODIFY Arg1:T93 Arg2:E44 T94 Detailed_description 2160 2180 posttraumatic origin R49 MODIFY Arg1:T94 Arg2:E42 T95 Therapeutic_procedure 2207 2222 Valvular repair E45 Therapeutic_procedure:T95 T96 Therapeutic_procedure 2259 2265 suture E46 Therapeutic_procedure:T96 R50 SUB_PROCEDURE Arg1:E46 Arg2:E45 T97 Therapeutic_procedure 2395 2404 extubated E47 Therapeutic_procedure:T97 T98 Therapeutic_procedure 2426 2445 postsurgical course E48 Therapeutic_procedure:T98 T99 Lab_value 2450 2463 uncomplicated R51 MODIFY Arg1:T99 Arg2:E48 T100 Date 2465 2479 One year later E49 Date:T100 T101 Sign_symptom 2488 2500 asymptomatic E50 Sign_symptom:T101 T102 Clinical_event 2519 2528 follow-up E51 Clinical_event:T102 T103 Diagnostic_procedure 2543 2557 echocardiogram E52 Diagnostic_procedure:T103 T104 Biological_structure 2529 2542 transthoracic R52 MODIFY Arg1:T104 Arg2:E52 T105 Lab_value 2558 2588 confirmed the excellent result R53 MODIFY Arg1:T105 Arg2:E52 T106 Therapeutic_procedure 2301 2309 stitches E53 Therapeutic_procedure:T106 T107 Detailed_description 2289 2300 5-0 Prolene T108 Detailed_description 2283 2288 three R54 MODIFY Arg1:T107 Arg2:E53 R55 MODIFY Arg1:T108 Arg2:E53 R56 SUB_PROCEDURE Arg1:E53 Arg2:E46 T109 Therapeutic_procedure 2353 2377 mitral annuloplasty ring E54 Therapeutic_procedure:T109 R57 SUB_PROCEDURE Arg1:E54 Arg2:E45 T110 Distance 2347 2352 30-mm R58 MODIFY Arg1:T110 Arg2:E54 T111 Clinical_event 55 64 presented E55 Clinical_event:T111 R59 AFTER Arg1:E55 Arg2:E1 * OVERLAP E1 E2 R60 AFTER Arg1:E2 Arg2:E3 * OVERLAP E3 E5 E4 E6 E7 E8 E9 E10 E11 E12 E13 E14 R61 BEFORE Arg1:E14 Arg2:E15 * OVERLAP E15 E16 R62 AFTER Arg1:E16 Arg2:E17 R63 BEFORE Arg1:E17 Arg2:E18 T112 Duration 833 841 one year E56 Duration:T112 * OVERLAP E18 E56 R64 BEFORE Arg1:E56 Arg2:E19 * OVERLAP E19 E20 E21 E22 E23 E24 E25 E26 E28 E27 E29 R65 BEFORE Arg1:E29 Arg2:E30 * OVERLAP E30 E31 E32 E57 E33 T113 Clinical_event 1431 1438 planned E57 Clinical_event:T113 R66 BEFORE Arg1:E33 Arg2:E34 * OVERLAP E34 E36 E37 E38 E39 E40 E41 E43 E44 E42 R67 BEFORE Arg1:E42 Arg2:E45 R68 BEFORE Arg1:E45 Arg2:E47 R69 BEFORE Arg1:E47 Arg2:E48 R70 BEFORE Arg1:E48 Arg2:E49 * OVERLAP E49 E50 E51 E52 E58 T114 Outcome 2572 2588 excellent result E58 Outcome:T114