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It was the first time I encountered such a structure while reading an academic book. At first I thought it was a mistake, but then I thought it didn't look like it. I've been studying English a lot lately. Maybe my brain is tired. Maybe it's something very simple. I'd like you to take a look.

What does “which” refer to ? What's ''given'' short for? Can you write a similar sentence from daily life?

I quote the sentence from the book as it is :

This is also suggested by the provocation of coughing by palpation of the trachea at the thoracic inlet, which suggests tracheal collapse specifically. Although the dog has a grade IV/VI pansystolic left apical murmur, which, given its age, breed and progression, is most likely due to myxomatous mitral valve disease, there are features that suggest that the dog has not previously been in congestive heart failure

Note : Please do not get confused with medical terms. Think in terms of the whole. For example :

a grade IV/VI pansystolic left apical murmur

myxomatous mitral valve disease

Thank you.

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    which has as its antecedent the apical murmur. "... which ... is most likely due to myxomatous mitral valve disease". The antecedent of its is the dog. But "progression" does not fit. The author got confused. Unless "progression" is a technical term that refers to the dog's progress through the disease, and not the murmur's development. But I would expect progression to refer to the mitral valve disease.
    – TimR
    Commented Apr 30 at 17:05
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    If what I think was intended is correct, I would write, "... left apical murmur which is most likely due to myxomatous mitral valve disease, given the dog's [or its] age and breed and the progression of the disease".
    – TimR
    Commented Apr 30 at 17:12
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    given introduces a fact or set of facts. Given our client's desire to live near water, we should send him pictures of lakeside homes and beach houses in his price range. The phrase headed by given is the basis for some course of action or some logical conclusion.
    – TimR
    Commented Apr 30 at 17:25
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    "The Cook could not have murdered Colonel Mustard in the bell tower, given the Cook's fear of heights."
    – TimR
    Commented Apr 30 at 17:32
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    What @TimR said. It's slightly jarring that given its age and [given its] breed clearly refer to the dog itself, but [given its] progression doesn't match that prior context, because it refers to the progression of the disease, not the dog. So - imperfect / clumsy phrasing, but no problems with the meaning.
    – FumbleFingers
    Commented Apr 30 at 18:56

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Although the dog has a grade IV/VI pansystolic left apical murmur,

  • which, given its age, breed,
    [considering the dog's age and breed]
  • and progression,
    [progression has to refer to the disease, not the animal]

[it] is most likely due to myxomatous mitral valve disease, …

The bridge was repaired after several years given the council's dire financial situation.

Cambridge Dictionaries lists given as a preposition and says

knowing about or considering a particular thing:

  • Given his age, he's a remarkably fast runner.
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  • I referred to it as phrase on a hunch that nowadays given is considered a preposition. What do you bet they say about considering ... ? a participial construction or a prepositional phrase?
    – TimR
    Commented Apr 30 at 19:32
  • "considering": participial, not a prepositional phrase. I'm no maven where parts of speech is concerned, so I wouldn't bet a dime.
    – Mari-Lou A
    Commented Apr 30 at 20:03
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    It would be an e-dime. You could use it to park an e-v.
    – TimR
    Commented Apr 30 at 20:45

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