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Kunigo T, Oikawa R, Nomura M. Acute Kidney Injury and Mid-term Outcomes After Extra-Cardiac Fontan Conversion. Pediatr Cardiol 2023:10.1007/s00246-023-03220-y. [PMID: 37355505 DOI: 10.1007/s00246-023-03220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
The aim of this study was to investigate the association of postoperative acute kidney injury and unplanned re-admission rate due to heart failure at 2 years follow-up in patients who had extra-cardiac Fontan conversion. This was a retrospective single-center study of patients who underwent conversion from classic Fontan to extra-cardiac Fontan between January 2014 and December 2021. Acute kidney injury was defined using the Kidney Disease Improving Global Outcomes criteria. A total of 47 patients underwent Fontan conversion. Acute kidney injury occurred in 22 patients (46.8%) and 5 patients with acute kidney injury needed renal replacement therapy. Unplanned re-admission rate at 2-year follow-up was significantly higher in patients with acute kidney injury even when renal function returned to baseline (8 [36.4%] vs. 3 [12.0%], p = 0.026 by the log-rank test). In conclusion, postoperative acute kidney injury after extra-cardiac Fontan conversion was associated with unplanned re-admission due to heart failure at 2-year follow-up even though renal function was recovered.
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Affiliation(s)
- Tatsuya Kunigo
- Department of Anesthesiology, Sapporo Medical University, School of Medicine, 291 South 1 West 16, Chuo-Ku, Sapporo-Shi, Hokkaido, 060-8543, Japan.
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
| | - Risa Oikawa
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Minoru Nomura
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
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Patel SR, Costello JM, Andrei AC, Backer CL, Krawczeski CD, Deal BJ, Langman CB, Marino BS. Incidence, Predictors, and Impact of Postoperative Acute Kidney Injury Following Fontan Conversion Surgery in Young Adult Fontan Survivors. Semin Thorac Cardiovasc Surg 2021; 34:631-639. [PMID: 33691191 DOI: 10.1053/j.semtcvs.2021.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
Acute kidney injury (AKI) is a common complication following single ventricle congenital heart surgery. Data regarding AKI following Fontan conversion (FC) surgery are limited. This study evaluated the incidence, predictors of, and prognostic value of AKI following FC. Single-center retrospective cohort study, including consecutive FC patients from December 1994 to December 2016. Medical records were reviewed. AKI was classified into AKI-1/AKI-2/AKI-3 using Kidney Disease: Improving Global Outcomes criteria. Multivariable logistic regression identified risk factors for AKI≥2. Chi-square and 2-sample t-tests assessed associations between AKI≥2 and postoperative outcomes. Mid-term heart-transplant-free survival among AKI0-1 vs AKI2-3 groups was compared using Kaplan-Meier curves and log-rank test. We included 139 FC patients: age at FC 24 (25th-75th, 19-31) years; 81% initial atrio-pulmonary Fontan; follow-up 8.3 ± 5.3 years following FC. Post-FC, 63 patients (45%) developed AKI (AKI-1 = 37 [27%]; AKI-2 = 10 [7%]; AKI-3 = 16 [11%]). AKI recovered by hospital discharge in 86%, 80%, and 19% of patients with AKI-1/AKI-2/AKI-3, respectively. Independent risk factors for AKI≥2 included older age (OR 1.07, 95%CI 1.01-1.15; P = 0.027); ≥3 prior sternotomies (OR = 6.11; 95%CI = 1.59-23.47; P = 0.009); greater preoperative right atrial pressure (OR 1.19; 1.02-1.38; P = 0.024), and prior catheter ablation procedure (OR 3.45; 1.17-10.18; P = 0.036). AKI≥2 was associated with: longer chest tube duration (9 [5-57] vs 7 [3-28] days; P = 0.01); longer mechanical ventilation time (2 [1-117] vs 1 [1-6] days; P = 0.01); greater need for dialysis (31% v s0%; P < 0.001); and longer postoperative length of stay (18 [8-135] vs 10 [6-58] days; P < 0.001). AKI 2-3 patients had worse mid-term heart-transplant-free survival. Half of the patients undergoing FC develop AKI. AKI 2-3 is associated with worse early postoperative outcomes and reduced mid-term transplant-free survival following FC. Knowledge of AKI predictors may allow for improved FC risk stratification, patient selection, and perioperative management in this high-risk population.
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Affiliation(s)
- Sheetal R Patel
- Division of Cardiology, Ann & Robert H Lurie Children's Hospital of Chicago, Department of Pediatrics at Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - John M Costello
- Division of Cardiology, Medical University of South Carolina Shawn Jenkins Children's Hospital, Department of Pediatrics at Medical University of South Carolina, Charleston, South Carolina
| | - Adin-Cristian Andrei
- Department of Preventive Medicine at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Carl L Backer
- Division of Cardiothoracic Surgery, Kentucky Children Hospital, Division of surgery at University of Kentucky, Lexington, Kentucky
| | - Catherine D Krawczeski
- Division of Cardiology, Nationwide Children's Hospital, Department of Pediatrics at The Ohio State University, Columbus, Ohio
| | - Barbara J Deal
- Division of Cardiology, Ann & Robert H Lurie Children's Hospital of Chicago, Department of Pediatrics at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Craig B Langman
- Division of Kidney Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Department of Pediatrics at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bradley S Marino
- Division of Cardiology, Ann & Robert H Lurie Children's Hospital of Chicago, Department of Pediatrics at Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Lee A, Concepcion W, Gonzales S, Sutherland SM, Hollander SA. Acute kidney injury and chronic kidney disease after combined heart-liver transplant in patients with congenital heart disease: A retrospective case series. Pediatr Transplant 2020; 24:e13833. [PMID: 32985770 DOI: 10.1111/petr.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
Although it is known that children undergoing heart transplantation are at increased risk for both AKI and CKD, renal function following CHLT remains understudied. All pediatric CHLT patients from 2006 to 2019 were included. The prevalence of AKI in the first 7 post-operative days, renal recovery at 30 post-operative days, and CKD were ascertained. AKI was defined as an increase in creatinine greater than 1.5 times baseline, and CKD, as an eCrCl less than 90 mL/min/1.73 m2 . The need for RRT was also analyzed. 10 patients were included, with an average age of 20 years and an average listing time of 130 days. Preoperatively, the median eCrCl was 91.12 mL/min/m2 (IQR 70.51, 127.75 min/mL/m2 ). 5 (50%) patients had CKD, with 4 at stage 2 and 1 at stage 3. AKI occurred post-operatively in 3 of 9 (33%) patients: 2 at stage 1 and 1 at stage 2. 2 (67%) resolved by 7 days. Of the 5 patients who reached their 1-year follow-up, 1 (20%) had stage 3 CKD. Among 2 patients, neither had CKD at 5 years. One patient required RRT 2 weeks after CHLT. Despite an increased prevalence of preoperative CKD, patients undergoing CHLT have a lower AKI prevalence than those receiving an isolated heart or liver transplant. Of those with AKI, early renal recovery is common, although at 1 year CKD remains present in 20%. Among long-term survivors, normal renal function is achievable.
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Affiliation(s)
- Angela Lee
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Waldo Concepcion
- Division of Abdominal Transplantation, Department of General Surgery, Stanford University, Stanford, California, USA
| | - Selena Gonzales
- Division of Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Scott M Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Seth A Hollander
- Division of Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA
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Rychik J, Atz AM, Celermajer DS, Deal BJ, Gatzoulis MA, Gewillig MH, Hsia TY, Hsu DT, Kovacs AH, McCrindle BW, Newburger JW, Pike NA, Rodefeld M, Rosenthal DN, Schumacher KR, Marino BS, Stout K, Veldtman G, Younoszai AK, d'Udekem Y. Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e234-e284. [PMID: 31256636 DOI: 10.1161/cir.0000000000000696] [Citation(s) in RCA: 407] [Impact Index Per Article: 81.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It has been 50 years since Francis Fontan pioneered the operation that today bears his name. Initially designed for patients with tricuspid atresia, this procedure is now offered for a vast array of congenital cardiac lesions when a circulation with 2 ventricles cannot be achieved. As a result of technical advances and improvements in patient selection and perioperative management, survival has steadily increased, and it is estimated that patients operated on today may hope for a 30-year survival of >80%. Up to 70 000 patients may be alive worldwide today with Fontan circulation, and this population is expected to double in the next 20 years. In the absence of a subpulmonary ventricle, Fontan circulation is characterized by chronically elevated systemic venous pressures and decreased cardiac output. The addition of this acquired abnormal circulation to innate abnormalities associated with single-ventricle congenital heart disease exposes these patients to a variety of complications. Circulatory failure, ventricular dysfunction, atrioventricular valve regurgitation, arrhythmia, protein-losing enteropathy, and plastic bronchitis are potential complications of the Fontan circulation. Abnormalities in body composition, bone structure, and growth have been detected. Liver fibrosis and renal dysfunction are common and may progress over time. Cognitive, neuropsychological, and behavioral deficits are highly prevalent. As a testimony to the success of the current strategy of care, the proportion of adults with Fontan circulation is increasing. Healthcare providers are ill-prepared to tackle these challenges, as well as specific needs such as contraception and pregnancy in female patients. The role of therapies such as cardiovascular drugs to prevent and treat complications, heart transplantation, and mechanical circulatory support remains undetermined. There is a clear need for consensus on how best to follow up patients with Fontan circulation and to treat their complications. This American Heart Association statement summarizes the current state of knowledge on the Fontan circulation and its consequences. A proposed surveillance testing toolkit provides recommendations for a range of acceptable approaches to follow-up care for the patient with Fontan circulation. Gaps in knowledge and areas for future focus of investigation are highlighted, with the objective of laying the groundwork for creating a normal quality and duration of life for these unique individuals.
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Young B, Franklin W, Lam W, Ermis P. Single-center experience of hemodialysis in patients after Fontan palliation. IJC HEART & VASCULATURE 2018; 21:94-95. [PMID: 30417073 PMCID: PMC6218632 DOI: 10.1016/j.ijcha.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/13/2018] [Accepted: 10/21/2018] [Indexed: 12/04/2022]
Affiliation(s)
- Brian Young
- Department of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Wayne Franklin
- Department of Adult Congenital Heart Disease, Baylor College of Medicine, Houston, TX, United States of America
| | - Wilson Lam
- Department of Adult Congenital Heart Disease, Baylor College of Medicine, Houston, TX, United States of America
| | - Peter Ermis
- Department of Adult Congenital Heart Disease, Baylor College of Medicine, Houston, TX, United States of America
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Kay WA, Moe T, Suter B, Tennancour A, Chan A, Krasuski RA, Zaidi AN. Long Term Consequences of the Fontan Procedure and How to Manage Them. Prog Cardiovasc Dis 2018; 61:365-376. [PMID: 30236751 DOI: 10.1016/j.pcad.2018.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
In 1971, Fontan and Baudet described a surgical technique for successful palliation of patients with tricuspid atresia. Subsequently, this technique has been applied to treat most forms of functional single ventricles and has become the current standard of care for long-term palliation of all patients with single ventricle congenital heart disease. Since 1971, the Fontan procedure has undergone several variations. These patients require lifelong management including a thorough knowledge of their anatomic substrate, hemodynamic status, management of rhythm and ventricular function along with multi organ evaluation. As these patients enter middle age, there is increasing awareness regarding the long-term complications and mortality. This review highlights the long-term outcomes of the Fontan procedure and management of late sequelae.
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Affiliation(s)
- W Aaron Kay
- Indiana University School of Medicine, Krannert Institute of Cardiology, IN.
| | - Tabitha Moe
- University of Arizona School of Medicine, Phoenix, AZ.
| | - Blair Suter
- Indiana University School of Medicine, Departments of Medicine and Pediatrics, IN.
| | - Andrea Tennancour
- Indiana University School of Medicine, Krannert Institute of Cardiology, IN.
| | - Alice Chan
- Children's Hospital at Montefiore, Montefiore Medical Center, Albert Einstein College of Medicine, NY.
| | | | - Ali N Zaidi
- Children's Hospital at Montefiore, Montefiore Medical Center, Albert Einstein College of Medicine, NY.
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Garcia Ropero A, Baskar S, Roos Hesselink JW, Girnius A, Zentner D, Swan L, Ladouceur M, Brown N, Veldtman GR. Pregnancy in Women With a Fontan Circulation. Circ Cardiovasc Qual Outcomes 2018; 11:e004575. [DOI: 10.1161/circoutcomes.117.004575] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/20/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Alvaro Garcia Ropero
- Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain (A.G.R.)
| | - Shankar Baskar
- Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (S.B. G.R.V., N.B.)
| | - Jolien W. Roos Hesselink
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.W.R.H., N.B., G.R.V.)
| | - Andrea Girnius
- Department of Anesthesiology, University of Cincinnati, OH (A.G.)
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia (D.Z.)
| | - Lorna Swan
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (L.S.)
| | - Magalie Ladouceur
- Department of Adult Congenital Heart Disease, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris Descartes University, Sorbonne Paris Cité, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.)
| | - Nicole Brown
- Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (S.B. G.R.V., N.B.)
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.W.R.H., N.B., G.R.V.)
| | - Gruschen R. Veldtman
- Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (S.B. G.R.V., N.B.)
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (J.W.R.H., N.B., G.R.V.)
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8
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Veldtman GR, Opotowsky AR, Wittekind SG, Rychik J, Penny DJ, Fogel M, Marino BS, Gewillig M. Cardiovascular adaptation to the Fontan circulation. CONGENIT HEART DIS 2017; 12:699-710. [DOI: 10.1111/chd.12526] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Gruschen R. Veldtman
- Adolescent and Adult Congenital Program; Heart Institute, Cincinnati Children's Hospital Medical Centre; Cincinnati Ohio, USA
| | | | - Samuel G. Wittekind
- Adolescent and Adult Congenital Program; Heart Institute, Cincinnati Children's Hospital Medical Centre; Cincinnati Ohio, USA
| | - Jack Rychik
- The Cardiac Center at The Children's Hospital of Philadelphia, Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania, USA
| | - Daniel J. Penny
- Department of Cardiology; Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine; Houston Texas, USA
| | - Mark Fogel
- The Cardiac Center at The Children's Hospital of Philadelphia, Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania, USA
| | - Bradley S. Marino
- Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois, USA
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9
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Sharma S, Ruebner RL, Furth SL, Dodds KM, Rychik J, Goldberg DJ. Assessment of Kidney Function in Survivors Following Fontan Palliation. CONGENIT HEART DIS 2016; 11:630-636. [DOI: 10.1111/chd.12358] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sheena Sharma
- Division of Nephrology and; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania USA
| | - Rebecca L Ruebner
- Division of Nephrology and; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania USA
| | - Susan L Furth
- Division of Nephrology and; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania USA
| | - Kathryn M Dodds
- Division of Cardiology; The Children's Hospital of Philadelphia; Philadelphia Pa USA
| | - Jack Rychik
- Division of Cardiology; The Children's Hospital of Philadelphia; Philadelphia Pa USA
| | - David J Goldberg
- Division of Cardiology; The Children's Hospital of Philadelphia; Philadelphia Pa USA
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D’Souza TF, Samuel BP, Hillman ND, Vettukattil JJ, Haw MP. Biventricular Repair of Pulmonary Atresia After Fontan Palliation. Ann Thorac Surg 2016; 101:1574-6. [DOI: 10.1016/j.athoracsur.2015.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/27/2015] [Accepted: 05/04/2015] [Indexed: 10/22/2022]
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Romfh A, Pluchinotta FR, Porayette P, Valente AM, Sanders SP. Congenital Heart Defects in Adults : A Field Guide for Cardiologists. ACTA ACUST UNITED AC 2012. [PMID: 24294540 DOI: 10.4172/2155-9880.s8-007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Advances in cardiology and cardiac surgery allow a large proportion of patients with congenital heart defects to survive into adulthood. These patients frequently develop complications characteristic of the defect or its treatment. Consequently, adult cardiologists participating in the care of these patients need a working knowledge of the more common defects. Occasionally, patients with congenital heart defects such as atrial septal defect, Ebstein anomaly or physiologically corrected transposition of the great arteries present for the first time in adulthood. More often patients previously treated in pediatric cardiology centers have transitioned to adult congenital heart disease centers for ongoing care. Some of the more important defects in this category are tetralogy of Fallot, transposition of the great arteries, functionally single ventricle defects, and coarctation. Through this field guide, we provide an overview of the anatomy of selected defects commonly seen in an adult congenital practice using pathology specimens and clinical imaging studies. In addition, we describe the physiology, clinical presentation to the adult cardiologist, possible complications, treatment options, and outcomes.
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Affiliation(s)
- Anitra Romfh
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA ; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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