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T1 Age 18 29 50-year old T2 Sex 30 33 man T3 Sign_symptom 48 74 aortic valve insufficiency E1 Sign_symptom:T3 T4 Detailed_description 39 47 bicuspid R1 MODIFY Arg1:T4 Arg2:E1 T5 Sign_symptom 89 105 aorta dilatation E2 Sign_symptom:T5 T6 Detailed_description 79 88 ascending R2 MODIFY Arg1:T6 Arg2:E2 T7 Therapeutic_procedure 143 165 homograft implantation E3 Therapeutic_procedure:T7 T8 Biological_structure 136 142 aortic T9 Detailed_description 126 135 free-hand R3 MODIFY Arg1:T8 Arg2:E3 R4 MODIFY Arg1:T9 Arg2:E3 T10 Therapeutic_procedure 171 182 replacement E4 Therapeutic_procedure:T10 T11 Biological_structure 190 208 non-coronary sinus R5 MODIFY Arg1:T11 Arg2:E4 T12 Detailed_description 217 232 24-mm homograft R6 MODIFY Arg1:T12 Arg2:E4 T13 Date 236 240 2006 E5 Date:T13 T14 Clinical_event 261 270 Follow-up E6 Clinical_event:T14 T15 Frequency 298 312 every 6 months R7 MODIFY Arg1:T15 Arg2:E6 T16 Sign_symptom 329 355 aortic valve insufficiency E7 Sign_symptom:T16 T17 Severity 324 328 mild R8 MODIFY Arg1:T17 Arg2:E7 T18 Clinical_event 374 383 follow-up E8 Clinical_event:T18 T19 Duration 363 370 8 years E9 Duration:T19 T20 Clinical_event 397 406 presented E10 Clinical_event:T20 T21 Nonbiological_location 410 418 hospital R9 MODIFY Arg1:T21 Arg2:E10 T22 Sign_symptom 424 429 fever E11 Sign_symptom:T22 T23 Diagnostic_procedure 438 454 echocardiography E12 Diagnostic_procedure:T23 T24 Sign_symptom 469 489 aortic insufficiency E13 Sign_symptom:T24 T25 Severity 462 468 severe R10 MODIFY Arg1:T25 Arg2:E13 T26 Sign_symptom 499 506 rupture E14 Sign_symptom:T26 T27 Biological_structure 510 543 one of the cusps of the homograft R11 MODIFY Arg1:T27 Arg2:E14 T28 Diagnostic_procedure 558 579 cardiac contractility E15 Diagnostic_procedure:T28 T29 Lab_value 545 554 worsening R12 MODIFY Arg1:T29 Arg2:E15 T30 Diagnostic_procedure 585 619 left ventricular ejection fraction E16 Diagnostic_procedure:T30 T31 Diagnostic_procedure 621 625 LVEF E17 Diagnostic_procedure:T31 R13 IDENTICAL Arg1:E17 Arg2:E16 T32 Lab_value 627 637 depression R14 MODIFY Arg1:T32 Arg2:E16 T33 Sign_symptom 651 683 dilatation of the left ventricle E18 Sign_symptom:T33 T34 Lab_value 639 645 40–45% R15 MODIFY Arg1:T34 Arg2:E16 T35 Lab_value 685 730 telediastolic/telesystolic diameters 60/42 mm R16 MODIFY Arg1:T35 Arg2:E18 T36 Sign_symptom 769 779 orthopnoea E19 Sign_symptom:T36 T37 Sign_symptom 784 795 hypotension E20 Sign_symptom:T37 T38 Medication 822 830 dopamine E21 Medication:T38 T39 Medication 835 844 diuretics E22 Medication:T39 T40 Administration 810 818 infusion R17 MODIFY Arg1:T40 Arg2:E21 R18 MODIFY Arg1:T40 Arg2:E22 T41 Diagnostic_procedure 846 865 Computed tomography E23 Diagnostic_procedure:T41 T42 Sign_symptom 878 892 calcifications E24 Sign_symptom:T42 T43 Biological_structure 900 909 homograft R19 MODIFY Arg1:T43 Arg2:E24 T44 Sign_symptom 911 928 pleural effusions E25 Sign_symptom:T44 T45 Sign_symptom 945 965 pericardial effusion E26 Sign_symptom:T45 A1 POLARITY E26 NEG T46 Diagnostic_procedure 985 1016 Dukes criteria for endocarditis E27 Diagnostic_procedure:T46 T47 Lab_value 1022 1035 not satisfied R20 MODIFY Arg1:T47 Arg2:E27 T48 Disease_disorder 1070 1094 structural deterioration E28 Disease_disorder:T48 T49 Biological_structure 1102 1111 homograft R21 MODIFY Arg1:T49 Arg2:E28 T50 Sign_symptom 1129 1142 calcification E29 Sign_symptom:T50 T51 Severity 1122 1128 severe R22 MODIFY Arg1:T51 Arg2:E29 R23 CAUSE Arg1:E29 Arg2:E28 T52 Therapeutic_procedure 1195 1207 resternotomy E30 Therapeutic_procedure:T52 T53 Detailed_description 1188 1194 median R24 MODIFY Arg1:T53 Arg2:E30 T54 Therapeutic_procedure 1245 1264 central cannulation E31 Therapeutic_procedure:T54 T55 Biological_structure 1226 1244 aorta-right atrium R25 MODIFY Arg1:T55 Arg2:E31 T56 Detailed_description 1217 1225 standard R26 MODIFY Arg1:T56 Arg2:E31 T57 Disease_disorder 1395 1407 endocarditis E32 Disease_disorder:T57 A2 POLARITY E32 NEG T58 Sign_symptom 1364 1378 calcifications E33 Sign_symptom:T58 T59 Severity 1357 1363 severe R27 MODIFY Arg1:T59 Arg2:E33 T60 Biological_structure 1305 1313 leaflets T61 Biological_structure 1337 1346 homograft T62 Biological_structure 1322 1329 annulus R28 MODIFY Arg1:T62 Arg2:T61 R29 MODIFY Arg1:T60 Arg2:T61 R30 MODIFY Arg1:T61 Arg2:E33 T63 Therapeutic_procedure 1470 1479 implanted E34 Therapeutic_procedure:T63 T64 Therapeutic_procedure 1439 1452 bioprosthesis E35 Therapeutic_procedure:T64 R31 SUB_PROCEDURE Arg1:E35 Arg2:E34 T65 Detailed_description 1423 1438 Edwards Intuity R32 MODIFY Arg1:T65 Arg2:E35 T66 Therapeutic_procedure 1493 1507 cross-clamping E36 Therapeutic_procedure:T66 T67 Therapeutic_procedure 1533 1555 cardiopulmonary bypass E37 Therapeutic_procedure:T67 R33 SUB_PROCEDURE Arg1:E36 Arg2:E34 R34 SUB_PROCEDURE Arg1:E37 Arg2:E34 T68 Duration 1565 1571 64 min E38 Duration:T68 T69 Duration 1517 1523 41 min E39 Duration:T69 R35 MODIFY Arg1:E39 Arg2:E36 R36 MODIFY Arg1:E38 Arg2:E37 T70 Medication 1594 1602 dopamine E40 Medication:T70 T71 Medication 1607 1617 adrenaline E41 Medication:T71 T72 Dosage 1621 1630 low doses R37 MODIFY Arg1:T72 Arg2:E41 R38 MODIFY Arg1:T72 Arg2:E40 T73 Sign_symptom 1654 1667 complications E42 Sign_symptom:T73 A3 POLARITY E42 NEG T74 Diagnostic_procedure 1710 1726 Echocardiography E43 Diagnostic_procedure:T74 T75 Clinical_event 1738 1747 discharge E44 Clinical_event:T75 T76 Sign_symptom 1770 1788 paravalvular leaks E45 Sign_symptom:T76 A4 POLARITY E45 NEG T77 Diagnostic_procedure 1792 1817 peak/mean aortic gradient E46 Diagnostic_procedure:T77 T78 Lab_value 1821 1831 34/20 mmHg R39 MODIFY Arg1:T78 Arg2:E46 T79 Diagnostic_procedure 1839 1843 LVEF E47 Diagnostic_procedure:T79 T80 Lab_value 1847 1850 33% R40 MODIFY Arg1:T80 Arg2:E47 T81 Diagnostic_procedure 1862 1878 echocardiography E48 Diagnostic_procedure:T81 T82 Date 1879 1893 after 3 months E49 Date:T82 T83 Sign_symptom 1928 1933 leaks E50 Sign_symptom:T83 A5 POLARITY E50 NEG T84 Sign_symptom 1938 1950 malfunctions E51 Sign_symptom:T84 A6 POLARITY E51 NEG T85 Biological_structure 1974 1984 prosthesis R41 MODIFY Arg1:T85 Arg2:E51 #1 AnnotatorNotes T85 Note this is a therapeutic above but a bio structure here; it is now part of the patient T86 Detailed_description 1958 1973 Edwards Intuity R42 MODIFY Arg1:T86 Arg2:T85 T87 Diagnostic_procedure 1988 2006 peak/mean gradient E52 Diagnostic_procedure:T87 T88 Lab_value 2010 2020 38/22 mmHg R43 MODIFY Arg1:T88 Arg2:E52 T89 Diagnostic_procedure 2049 2053 LVEF E53 Diagnostic_procedure:T89 T90 Lab_value 2025 2041 initial recovery R44 MODIFY Arg1:T90 Arg2:E53 T91 Lab_value 2062 2065 47% R45 MODIFY Arg1:T91 Arg2:E53 T92 Sign_symptom 2080 2092 asymptomatic E54 Sign_symptom:T92 * OVERLAP E1 E2 R46 BEFORE Arg1:E2 Arg2:E3 * OVERLAP E3 E4 E5 R47 BEFORE Arg1:E5 Arg2:E6 * OVERLAP E6 E7 R48 MODIFY Arg1:E9 Arg2:E8 R49 BEFORE Arg1:E7 Arg2:E9 * OVERLAP E9 E8 R50 BEFORE Arg1:E8 Arg2:E10 * OVERLAP E10 E11 E12 E13 E14 E15 E16 E18 E19 E20 E21 E22 E23 E24 E25 E26 E27 E28 E29 R51 CAUSE Arg1:E14 Arg2:E13 T93 Therapeutic_procedure 1156 1165 operation E55 Therapeutic_procedure:T93 R52 SUB_PROCEDURE Arg1:E30 Arg2:E55 R53 SUB_PROCEDURE Arg1:E31 Arg2:E55 R54 BEFORE Arg1:E29 Arg2:E55 * OVERLAP E55 E33 E32 E34 E40 E41 T94 Therapeutic_procedure 1688 1708 postoperative period E56 Therapeutic_procedure:T94 R55 BEFORE Arg1:E41 Arg2:E42 * OVERLAP E42 E56 R56 BEFORE Arg1:E56 Arg2:E43 R57 BEFORE Arg1:E43 Arg2:E44 R58 AFTER Arg1:E44 Arg2:E45 * OVERLAP E45 E46 E47 R59 BEFORE Arg1:E47 Arg2:E48 * OVERLAP E48 E49 E50 E51 E52 E53 E54