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Cardiac Imaging in Valvular Heart Disease
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Cardiac Imaging in Valvular Heart Disease

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Imaging".

Deadline for manuscript submissions: closed (15 March 2023) | Viewed by 38034

Special Issue Editors

Dr. Francesco Faletra

E-Mail Website
Guest Editor
Director of Cardiac Imaging, EOC Istituto Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
Interests: 3D transesophageal echocardiography; magnetic resonance imaging; computed tomography; valvular and ischemic heart disease
Dr. Mauro Pepi

E-Mail Website
Guest Editor
Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
Interests: mitral valve prolapse; mitral valve regurgitation; cardiac CT
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Acquired valvular heart disease represents one of the most common causes of worldwide cardiovascular morbidity and mortality. In the developed countries, the decrease in prevalence of rheumatic heart diseases has been accompanied by an increase in age-related degenerative valve diseases. Aortic stenosis and mitral regurgitation are the two most common types of valvular disease in Europe. Endocarditis remains an important etiology of valvular disease. The burden of heart valve disease in the elderly has an important impact on patient management, given the high frequency of comorbidity and the increased surgical risk. To face this major limitation, novel percutaneous techniques have been developed. In these contexts, the role of cardiovascular imaging has become essential. The aim of this Special Issue will then be to systematically review the latest technical advances in the field of cardiovascular imaging to improve detection, grading and clinical management of valvular heart disease and to discuss the major challenges that the cardiovascular imager may be faced with. If transthoracic echocardiography still represents the first line exam, the new developments in 3D echocardiography, cardiovascular magnetic resonance, coronary computed tomography and nuclear medicine have proven to be effective in improving the decision-making and risk stratification of patients with valvular heart disease.

Dr. Francesco Faletra
Dr. Mauro Pepi
Guest Editors

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Keywords

  • 2D and 3D transthoracic echocardiography
  • 2D and 3D transesophageal echocardiography
  • cardiovascular magnetic resonance
  • coronary computed tomography angiography
  • mitral valve
  • aortic valve
  • tricuspid valve
  • percutaneous intervention
  • MitraClip
  • cardioband
  • transaortic valve replacement

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Published Papers (10 papers)

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Research

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15 pages, 1868 KiB  
Article
Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure
by Chieh-Ju Chao, Pradyumna Agasthi, Amith R. Seri, Timothy Barry, Anusha Shanbhag, Yuxiang Wang, Mackram F. Eleid, David Fortuin, John P. Sweeney, Peter Pollak, Abdallah El Sabbagh, Steven J. Lester, William K. Freeman, Tasneem Z. Naqvi, David R. Holmes, Christopher P. Appleton and Reza Arsanjani
J. Cardiovasc. Dev. Dis. 2023, 10(5), 192; https://doi.org/10.3390/jcdd10050192 - 26 Apr 2023
Viewed by 1780
Abstract
Background: Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve [...] Read more.
Background: Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve gradients. Methods: Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between 1 January 2012 and 30 June 2017 were identified to retrieve baseline clinical, echocardiographic and mortality data. AugSBP, AugMAP and valvulo-arterial impedance (Zva) (Zva) were evaluated using Cox regression. Receiver operating characteristic curve analysis and the c-index were used to assess the model performance against the Society of Thoracic Surgeons (STS) risk score. Results: The final cohort contained 974 patients with a mean age of 81.4 ± 8.3 years old, and 56.6% were male. The mean STS risk score was 8.2 ± 5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Both univariate and multivariate Cox regression showed that AugSBP and AugMAP parameters were independent predictors for intermediate-term post-TAVR mortality (all p < 0.0001). AugMAP1 < 102.5 mmHg was associated with a 3-fold-increased risk of all-cause mortality 1-year post-TAVR (hazard ratio 3.0, 95%confidence interval 2.0–4.5, p < 0.0001). A univariate model of AugMAP1 surpassed the STS score model in predicting intermediate-term post-TAVR mortality (area under the curve: 0.700 vs. 0.587, p = 0.005; c-index: 0.681 vs. 0.585, p = 0.001). Conclusions: Augmented mean arterial pressure provides clinicians with a simple but effective approach to quickly identify patients at risk and potentially improve post-TAVR prognosis. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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14 pages, 1390 KiB  
Article
Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair
by Elena Galli, Pierre Hubert, Guillaume Leurent, Vincent Auffret, Vasileios Panis, Guillaume L’Official and Erwan Donal
J. Cardiovasc. Dev. Dis. 2023, 10(3), 100; https://doi.org/10.3390/jcdd10030100 - 25 Feb 2023
Cited by 8 | Viewed by 2162
Abstract
Background: The noninvasive assessment of myocardial work (MW) allows for the evaluation of left ventricular (LV) performance by considering the effect of LV afterload. This study aims to evaluate the acute and chronic impact of transcatheter edge-to-edge repair (TEER) on MW parameters and [...] Read more.
Background: The noninvasive assessment of myocardial work (MW) allows for the evaluation of left ventricular (LV) performance by considering the effect of LV afterload. This study aims to evaluate the acute and chronic impact of transcatheter edge-to-edge repair (TEER) on MW parameters and LV remodeling in patients with severe primary mitral regurgitation (PMR). Methods: A total of 71 patients (age: 77 ± 9 years, females: 44%) with moderate–to-severe or severe PMR (effective regurgitant orifice: 0.57 ± 0.31 cm2; regurgitant volume: 80 ± 34 mL; LV end-systolic diameter: 42 ± 12 mm) underwent TEER after a global assessment by the heart team. MW indices were evaluated before the procedure, at hospital discharge, and at 1-year follow-up. LV remodeling was described as the percentage variation in LVEDV between baseline and 1-year follow-up. Results: TEER caused an acute reduction in LVEF, global longitudinal strain (GLS), global MW index (GWI), work efficiency (GWE), and mechanical dispersion (MD) and a significant increase in wasted work (GWW). One year after the procedure, GLS, GWI, GWE, and MD recovered, whereas GWW remained significantly impaired. Baseline GWW (β = −0.29, p = 0.03) was an independent predictor of LV reverse remodeling at 1-year follow-up. Conclusions: In patients with severe PMR undergoing TEER, the acute reduction in LV preload causes significant impairment to all the parameters of LV performance. Baseline GWW was the only independent predictor of LV reverse remodeling, suggesting that a lower myocardial energetic efficiency in the context of chronic preload increase might impact the left ventricular response to mitral regurgitation correction. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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14 pages, 15383 KiB  
Article
The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary Stenosis
by Hankun Yan, Na Zhao, Wenlei Geng, Zhihui Hou, Yang Gao and Bin Lu
J. Cardiovasc. Dev. Dis. 2022, 9(5), 128; https://doi.org/10.3390/jcdd9050128 - 23 Apr 2022
Cited by 4 | Viewed by 3291
Abstract
Background: Coronary computed tomography angiography (CCTA) is an established first-line test in the investigation of patients with suspected coronary artery disease (CAD), while the perivascular fat attenuation index (FAI) derived from CT seems to be a feasible and efficient tool for the identification [...] Read more.
Background: Coronary computed tomography angiography (CCTA) is an established first-line test in the investigation of patients with suspected coronary artery disease (CAD), while the perivascular fat attenuation index (FAI) derived from CT seems to be a feasible and efficient tool for the identification of ischemia. The association between the FAI and lesion-specific ischemia as assessed by fractional flow reserve (FFR) remains unclear. Methods: In a total of 261 patients, 294 vessels were assessed for CCTA stenosis, vessel-specific FAI, lesion-specific FAI, and plaque characteristics. The diagnostic accuracies of each parameter and the combined approach were analyzed via the receiver operating characteristic curve (ROC) with FFR as the reference standard. The determinants of FAI were statistically analyzed. Results: The cutoff values of vessel-specific FAI and lesion-specific FAI scores calculated according to the Youden index were −70.97 and −73.95 HU, respectively. No significant differences were noted between them; however, they exhibited a strong correlation. No significant differences were noted between the area under the curve (AUC) scores of vessel-specific FAI (0.677), lesion-specific FAI (0.665), and CCTA (0.607) (p > 0.05 for all) results. The addition of two FAI measures to the CCTA showed improvements in the discrimination (AUC) and reclassification ability (relative integrated discrimination improvement (IDI) and category-free net reclassification index (NRI)), vessel-specific FAI (AUC, 0.696; NRI, 49.6%; IDI, 5.9%), and lesion-specific FAI scores (AUC, 0.676; NRI, 43.3%; IDI, 5.4%); (p < 0.01 for all). Multivariate analysis revealed that low-attenuation plaque (LAP) volume was an independent predictor of two FAI measures. Conclusion: The combined approach of adding vessel-specific FAI or lesion-specific FAI scores could improve the identification of ischemia compared with CCTA alone. The LAP volume was the independent risk factor for both tools. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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Review

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12 pages, 4170 KiB  
Review
Real-Time Monitoring and Step-by-Step Guidance for Transcatheter Tricuspid Annuloplasty Using Transesophageal Echocardiography
by Yu Liu, Wei Li, Daxin Zhou, Xiaochun Zhang, Dehong Kong, Zhenyi Ge, Haiyan Chen, Xianhong Shu, Cuizhen Pan and Junbo Ge
J. Cardiovasc. Dev. Dis. 2022, 9(12), 415; https://doi.org/10.3390/jcdd9120415 - 25 Nov 2022
Cited by 4 | Viewed by 2028
Abstract
Transcatheter tricuspid valve intervention (TTVI) is a novel alternative to functional tricuspid regurgitation (FTR) for patients with prohibitive surgical risk. Devices have been designed according to different pathophysiological mechanisms of FTR, including ones to achieve an edge-to-edge repair and others aiming at direct [...] Read more.
Transcatheter tricuspid valve intervention (TTVI) is a novel alternative to functional tricuspid regurgitation (FTR) for patients with prohibitive surgical risk. Devices have been designed according to different pathophysiological mechanisms of FTR, including ones to achieve an edge-to-edge repair and others aiming at direct annuloplasty. Recently, a transcatheter tricuspid valve repair system mimicking a surgical Kay procedure (K-Clip™ system, Huihe Medical Technology, Shanghai, China) completed its salvage-use trial. The system, which clips the posterior annulus to achieve bicuspidization of the TV, demonstrated acceptable procedural safety and efficacy. Each TTVI system has distinct characteristics for echocardiographic imaging and special consideration for intraoperative guidance. This review focuses on elaborating how two-dimensional and three-dimensional transesophageal echocardiography (TEE) are used in clinical practice to guide K-Clip™ implantation in comparison to other direct annular reduction devices. A limited number of TEE work planes are proposed for the procedure with the aim to provide a steeper learning curve for the echocardiographer and interventionalist while simplifying the implantation steps. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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12 pages, 1428 KiB  
Review
The Role of Cardiovascular Magnetic Resonance in Patients with Mitral Regurgitation
by Anna Giulia Pavon, Marco Guglielmo, Pierpaolo Mattia Mennilli, Mariana B. L. Falcão, Luca Bergamaschi, David Filip Costantin, Michele Vivaldo, Laura Anna Leo, Susanne Schlossbauer, Christopher W. Roy, Matthias Stuber, Giovanni Pedrazzini and Francesco Faletra
J. Cardiovasc. Dev. Dis. 2022, 9(11), 399; https://doi.org/10.3390/jcdd9110399 - 18 Nov 2022
Cited by 4 | Viewed by 2952
Abstract
The 2019 Global Burden of Disease (GBD) study estimated that there were approximately 24.2 million people affected worldwide by degenerative mitral regurgitation (MR), resulting in 34,200 deaths. After aortic stenosis, MR is the most prevalent VHD in Europe and the second-most common VHD [...] Read more.
The 2019 Global Burden of Disease (GBD) study estimated that there were approximately 24.2 million people affected worldwide by degenerative mitral regurgitation (MR), resulting in 34,200 deaths. After aortic stenosis, MR is the most prevalent VHD in Europe and the second-most common VHD to pose indications for surgery in western countries. Current ESC and AHA/ACC guidelines for the management of VHD emphasize the importance of an integrative approach for the assessment of MR severity, which is of paramount importance in dictating the timing for surgery. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are the first-line imaging modalities; however, despite the technological advancement, sometimes, the final diagnosis on the degree of the disease may still be challenging. In the last 20 years, CMR has emerged as a robust technique in the assessment of patients with cardiac disease, and, recently, its role is gaining more and more importance in the field of VHD. In fact, CMR is the gold standard in the assessment of cardiac volumes, and it is possible to accurately evaluate the regurgitant volume. The purpose of this review is to outline the current state-of-the-art management of MR by using Cardiac Magnetic Resonance (CMR). Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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15 pages, 1277 KiB  
Review
The Role of Cardiac Magnetic Resonance in Aortic Stenosis and Regurgitation
by Marco Guglielmo, Chiara Rovera, Mark G. Rabbat and Gianluca Pontone
J. Cardiovasc. Dev. Dis. 2022, 9(4), 108; https://doi.org/10.3390/jcdd9040108 - 4 Apr 2022
Cited by 9 | Viewed by 5276
Abstract
Cardiac magnetic resonance (CMR) imaging is a well-set diagnostic technique for assessment of valvular heart diseases and is gaining ground in current clinical practice. It provides high-quality images without the administration of ionizing radiation and occasionally without the need of contrast agents. It [...] Read more.
Cardiac magnetic resonance (CMR) imaging is a well-set diagnostic technique for assessment of valvular heart diseases and is gaining ground in current clinical practice. It provides high-quality images without the administration of ionizing radiation and occasionally without the need of contrast agents. It offers the unique possibility of a comprehensive stand-alone assessment of the heart including biventricular function, left ventricle remodeling, myocardial fibrosis, and associated valvulopathies. CMR is the recognized reference for the quantification of ventricular volumes, mass, and function. A particular strength is the ability to quantify flow, especially with new techniques which allow accurate measurement of stenosis and regurgitation. Furthermore, tissue mapping enables the visualization and quantification of structural changes in the myocardium. In this way, CMR has the potential to yield important prognostic information predicting those patients who will progress to surgery and impact outcomes. In this review, the fundamentals of CMR in assessment of aortic valve diseases (AVD) are described, together with its strengths and weaknesses. This state-of-the-art review provides an updated overview of CMR potentials in all AVD issues, including valve anatomy, flow quantification, ventricular volumes and function, and tissue characterization. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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15 pages, 12612 KiB  
Review
The Role of Multimodality Imaging in Left-Sided Prosthetic Valve Dysfunction
by Manuela Muratori, Laura Fusini, Maria Elisabetta Mancini, Gloria Tamborini, Sarah Ghulam Ali, Paola Gripari, Marco Doldi, Antonio Frappampina, Giovanni Teruzzi, Gianluca Pontone, Piero Montorsi and Mauro Pepi
J. Cardiovasc. Dev. Dis. 2022, 9(1), 12; https://doi.org/10.3390/jcdd9010012 - 4 Jan 2022
Cited by 4 | Viewed by 4340
Abstract
Prosthetic valve (PV) dysfunction (PVD) is a complication of mechanical or biological PV. Etiologic mechanisms associated with PVD include fibrotic pannus ingrowth, thrombosis, structural valve degeneration, and endocarditis resulting in different grades of obstruction and/or regurgitation. PVD can be life threatening and often [...] Read more.
Prosthetic valve (PV) dysfunction (PVD) is a complication of mechanical or biological PV. Etiologic mechanisms associated with PVD include fibrotic pannus ingrowth, thrombosis, structural valve degeneration, and endocarditis resulting in different grades of obstruction and/or regurgitation. PVD can be life threatening and often challenging to diagnose due to the similarities between the clinical presentations of different causes. Nevertheless, identifying the cause of PVD is critical to treatment administration (thrombolysis, surgery, or percutaneous procedure). In this report, we review the role of multimodality imaging in the diagnosis of PVD. Specifically, this review discusses the characteristics of advanced imaging modalities underlying the importance of an integrated approach including 2D/3D transthoracic and transesophageal echocardiography, fluoroscopy, and computed tomography. In this scenario, it is critical to understand the strengths and weaknesses of each modality according to the suspected cause of PVD. In conclusion, for patients with suspected or known PVD, this stepwise imaging approach may lead to a simplified, more rapid, accurate and specific workflow and management. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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13 pages, 11148 KiB  
Review
The Role of 2D and 3D Echo in Mitral Stenosis
by Juan Manuel Monteagudo Ruiz and José Luis Zamorano Gómez
J. Cardiovasc. Dev. Dis. 2021, 8(12), 171; https://doi.org/10.3390/jcdd8120171 - 3 Dec 2021
Cited by 7 | Viewed by 5632
Abstract
Mitral stenosis is an important cause of heart valve disease globally. Echocardiography is the main imaging modality used to diagnose and assess the severity and hemodynamic consequences of mitral stenosis as well as valve morphology. Transthoracic echocardiography (TTE) is sufficient for the management [...] Read more.
Mitral stenosis is an important cause of heart valve disease globally. Echocardiography is the main imaging modality used to diagnose and assess the severity and hemodynamic consequences of mitral stenosis as well as valve morphology. Transthoracic echocardiography (TTE) is sufficient for the management of most patients. The focus of this review is the role of current two-dimensional (2D) and three-dimensional (3D) echocardiographic imaging for the evaluation of mitral stenosis. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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Other

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10 pages, 1043 KiB  
Case Report
Bioprosthetic Aortic Valve Thrombosis and Literature Review
by Milan Radovanovic, Charles W. Nordstrom and Richard D. Hanna
J. Cardiovasc. Dev. Dis. 2022, 9(8), 252; https://doi.org/10.3390/jcdd9080252 - 6 Aug 2022
Cited by 2 | Viewed by 2764
Abstract
An 83-year-old gentleman with a history of 23-mm Hancock-II-bioprosthetic aortic valve (BAV) replacement ten-years prior presented with symptoms of dyspnea and lower extremity edema. During the preceding seven-years, he had been noted to have asymptomatic increased mean transvalvular gradients (MG; 36–50 mmHg) felt [...] Read more.
An 83-year-old gentleman with a history of 23-mm Hancock-II-bioprosthetic aortic valve (BAV) replacement ten-years prior presented with symptoms of dyspnea and lower extremity edema. During the preceding seven-years, he had been noted to have asymptomatic increased mean transvalvular gradients (MG; 36–50 mmHg) felt to be due to either early bioprosthetic degeneration, pannus formation, or patient–prosthesis mismatch. An echocardiogram at the time of symptom development demonstrated significant flow acceleration through the aortic valve, mild regurgitation, and severely increased MG (48 mmHg) with prolonged acceleration time (AT, 140 msec). A trial of warfarin anticoagulation resulted in dramatic improvement after only 6 weeks with laminar flow through the AV, near-total resolution of regurgitation, and a decrease in MG to 14 mmHg and AT to 114 msec. These findings strongly suggest that BAV thrombosis was the predominant mechanism responsible for the longstanding high MG. Our case highlights that BAV thrombosis should be considered in the differential of elevated gradients regardless of the age of prosthesis, and that a trial of warfarin anticoagulation may be beneficial even if elevated gradients have been present for a prolonged period. Valvular gradients are often abnormal long before a formal diagnosis; however, these may reverse quickly with anticoagulation therapy. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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5 pages, 5503 KiB  
Case Report
Adult Presentation of Subaortic Stenosis with Subaortic Membrane Treated with Surgical Removal
by Se Hun Kang, In Jai Kim and Won-Jang Kim
J. Cardiovasc. Dev. Dis. 2022, 9(2), 36; https://doi.org/10.3390/jcdd9020036 - 21 Jan 2022
Cited by 5 | Viewed by 6653
Abstract
Subaortic stenosis (SAS) is a rare heart disease in adults with an unclear etiology and variable clinical presentation. In some cases, SAS appears as hypertrophic cardiomyopathy with obstruction due to the accompanying systolic anterior motion of the mitral valve. A 46-year-old male with [...] Read more.
Subaortic stenosis (SAS) is a rare heart disease in adults with an unclear etiology and variable clinical presentation. In some cases, SAS appears as hypertrophic cardiomyopathy with obstruction due to the accompanying systolic anterior motion of the mitral valve. A 46-year-old male with dizziness for several months presented in the outpatient department. Two-dimensional transthoracic echocardiography demonstrated a slightly hypertrophic left ventricle with normal systolic function without wall-motion abnormalities. Just below the aortic valve, a linear structure protruding from the septum side and the left-ventricular outflow tract (LVOT) side of the mitral valve was confirmed, which was causing a significant pressure gradient (mean and maximum of 91 mmHg and 138 mmHg, respectively). A diagnosis of SAS with subaortic membrane was made, and surgical myomectomy and subaortic membrane removal surgery were performed. Postoperative transthoracic echocardiography did not show flow acceleration through the LVOT, nor a significant pressure gradient across the aortic valve. This case report highlights the clinical significance of SAS with subaortic membrane, which can be confused with aortic stenosis of other etiology. Full article
(This article belongs to the Special Issue Cardiac Imaging in Valvular Heart Disease)
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