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Alomari M, El-Sayed Ahmed MM, Ali M, Wadiwala IJ, Pham SM, Sareyyupoglu B. Quadricuspid Aortic Valve: Imaging, Diagnosis, and Prognosis. Tex Heart Inst J 2024; 51:e238256. [PMID: 38686682 PMCID: PMC11075509 DOI: 10.14503/thij-23-8256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Quadricuspid aortic valve is a rare congenital cardiac anomaly with an incidence of 0.008% to 0.043%. Its clinical course varies depending on cusp anatomy, function, and associated cardiac malformations. It frequently progresses to aortic valve regurgitation that may require surgical valve replacement. Detection has shifted from incidental discovery during autopsies or cardiac surgeries in the early 20th century to various cardiac imaging methods in recent decades. In addition to contributing to the literature, this report supports the use of transesophageal echocardiography more liberally to detect aortic valve abnormalities. The case presents a 48-year-old female patient with an incidentally discovered quadricuspid aortic valve.
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Affiliation(s)
- Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Magdy M. El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
- Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Mostafa Ali
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ishaq J. Wadiwala
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Si M. Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
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Yu Y, Huang R, Ding Z, Shi E, Gu T. Surgical Repair of a Quadricuspid Aortic Valve With Severe Regurgitation Utilizing “Tricuspidization” and Annular Banding: A Case and Technique Details Report. Front Cardiovasc Med 2022; 9:871818. [PMID: 35592399 PMCID: PMC9110680 DOI: 10.3389/fcvm.2022.871818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
The quadricuspid aortic valve (QAV) is a rare congenital disease with a prevalence of 0. 013–0.043% of cardiac cases. Most patients with QAV are treated with aortic valve replacement. A Type B QAV with dilated ascending aorta of 47.9 mm; combined with severe regurgitation is reported here. In this case, considering the patient‘s cusps are flexible and reservable, the aortic root was reconstructed utilizing tricuspidization and annular banding technique, and dilated ascending aorta was replaced at the same time.
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Sohn J, Arain FD. Two Consecutive Cases of Quadricuspid Aortic Valve and a Review of 149 Cases. J Cardiothorac Vasc Anesth 2021; 36:717-723. [PMID: 33731298 DOI: 10.1053/j.jvca.2021.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Abstract
The quadricuspid aortic valve (QAV) is a rare congenital anomaly that typically is unrelated to other cardiac anomalies. It usually is discovered incidentally through imaging modalities such as echocardiogram or computed tomography angiogram, during surgery, or autopsy. Some patients with QAV develop aortic regurgitation and, rarely, other cardiovascular complications like aortic aneurysm. Due to its rarity, it is difficult to characterize these patients or standardize management. However, review of case reports can be very useful in rare medical conditions such as QAV. In this manuscript, in addition to presenting two cases of QAV, the authors reviewed 149 cases of QAV from 2010 to 2020 from published case studies and series in order to gain a better insight into the characteristics of the patient population with QAV and its management.
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Affiliation(s)
- Jacqueline Sohn
- University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - Faisal D Arain
- University Hospitals Cleveland Medical Center, Cleveland, OH
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Messner B, Bernhard D. Bicuspid aortic valve-associated aortopathy: Where do we stand? J Mol Cell Cardiol 2019; 133:76-85. [PMID: 31152748 DOI: 10.1016/j.yjmcc.2019.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 01/30/2023]
Abstract
Herein we summarize the current knowledge on the bicuspid aortic valve (BAV)-associated aortopathy regarding clinical presentation and disease sub-classification, genetic background, hemodynamics, histopathology, cells and signaling, animal models, and biomarkers. Despite enormous efforts in research in all of the above areas, important issues remain unknown: (i) what is the ontogenetic basis of BAV development? (ii) how can we explain the diversity of BAV and associated aortopathy phenotypes? (iii) what are the signaling processes in aortopathy pathogenesis and how can we interfere with these processes? Despite undoubtedly great progress that has been made in the understanding of BAV-associated aortopathy, so far researchers have put together a heap of Lego bricks, but at present it is unclear if the bricks are compatible, how they fit together, and which parts are missing to build the true model of the BAV aorta. A joint approach is needed to accelerate research progress.
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Affiliation(s)
- Barbara Messner
- Cardiac Surgery Research Laboratory, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - David Bernhard
- Center for Medical Research, Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
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A quadricuspid aortic valve in an asymptomatic 40-year-old man: a case report. J Med Case Rep 2018; 12:234. [PMID: 30111367 PMCID: PMC6094910 DOI: 10.1186/s13256-018-1755-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/27/2018] [Indexed: 11/24/2022] Open
Abstract
Background Integrated transthoracic and transesophageal echocardiography enables identification and characterization of a quadricuspid aortic valve anomaly. Case presentation A totally asymptomatic 40-year-old white man was referred to our Division of Cardiology after accidental finding of a heart murmur. Transesophageal echocardiography detected a quadricuspid aortic valve characterized by four cusps of equal size and severe aortic valvular regurgitation, without any further anomalies. He underwent a successful aortic valve repair. Conclusions Quadricuspid aortic valve anomaly is a rare congenital cardiac defect that can cause progressive valvular complications.
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Cheng CL, Chang HH, Wang WC, Huang PJ, Lin SY. New morphological classification of congenital quadricuspid aortic valve and its histopathologic features. Cardiovasc Pathol 2018; 35:8-11. [PMID: 29729634 DOI: 10.1016/j.carpath.2018.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/19/2018] [Accepted: 03/30/2018] [Indexed: 11/30/2022] Open
Abstract
We report a 52-year-old male patient who had a quadricuspid aortic valve (QAV) associated with aortic regurgitation (AR) and left ventricular hypertrophy (LVH). A new accessory cusp (ACC) with maximum thickness than other cusps was located between right coronary cusp (RCC) and left coronary cusp (LCC). The histopathological features revealed markedly thickened and distorted cusp architecture with fibrosis and/or myxomatous degeneration in both non-coronary cusp (NCC) and ACC. Two equal sizes for larger cusps (RCC and NCC) and two equal sizes for smaller cusps (LCC and ACC) were obtained. This QAV belonged to type C QAV of Hurwitz's classification, but also suggested as a modified type III of Jagannath's classification or a new type V of Nakamura's classification by locating ACC between RCC and LCC.
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MESH Headings
- Aortic Valve/abnormalities
- Aortic Valve/physiopathology
- Aortic Valve/transplantation
- Aortic Valve Insufficiency/pathology
- Aortic Valve Insufficiency/physiopathology
- Aortic Valve Insufficiency/surgery
- Biopsy
- Echocardiography, Doppler, Color
- Echocardiography, Transesophageal
- Fibrosis
- Heart Defects, Congenital/classification
- Heart Defects, Congenital/pathology
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Heart Valve Prosthesis Implantation
- Humans
- Hypertrophy, Left Ventricular/pathology
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Left Ventricular/surgery
- Male
- Middle Aged
- Treatment Outcome
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Affiliation(s)
- Ching-Li Cheng
- Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan.
| | - Hsiao-Huang Chang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Wei-Chen Wang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Jung Huang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shan-Yang Lin
- Department of Biotechnology and Pharmaceutical Technology, Yuanpei University of Medical Technology, Hsin Chu, Taiwan.
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Yuan SM. Quadricuspid Aortic Valve: A Comprehensive Review. Braz J Cardiovasc Surg 2017; 31:454-460. [PMID: 28076624 PMCID: PMC5407143 DOI: 10.5935/1678-9741.20160090] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/25/2016] [Indexed: 01/19/2023] Open
Abstract
Quadricuspid aortic valve (QAV) is a rare congenital heart disease. The
functional status of QAV is predominantly a pure aortic regurgitation. Clinical
manifestations of patients with a QAV depend on the functional status of the QAV
and the associated disorders. Significant valvular regurgitation and (or)
stenosis is often present with subsequent operation performed at the fifth to
sixth decade of life. The functional status of QAV is predominantly regurgitant;
whereas pure stenotic QAV can be as few as in only 0.7% of the patients. QAV is
usually an isolated anomaly, but other congenital heart defects can be present
in 18-32% of the patients. About one-fifth of them require a surgical operation.
Tricuspidalization is a preferred technique for QAV repair. As not all the
patients with a QAV necessarily warrant a surgical operation, decision-making in
patient selection and surgical procedure of choice are crucial. Antibiotic
prophylaxis against infective endocarditis is necessary in the QAV patients with
unequal-sized cusps.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, China
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Kim DY, Kim HW. Single coronary ostium in a patient with quadricuspid aortic valve combined with aneurysmal ascending aortic dilatation. J Cardiothorac Surg 2017; 12:59. [PMID: 28738863 PMCID: PMC5525266 DOI: 10.1186/s13019-017-0622-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/13/2017] [Indexed: 11/26/2022] Open
Abstract
Background The presence of a fourth aortic valve cusp (quadricupsid aortic valve) is a rare congenital malformation and is often accompanied by other anomalies of the adjacent cardiovascular structures. Among these concomitant anomalies, simultaneous association of both a single coronary ostium and aneurysmal ascending aortic dilation in combination with the quadricupsid aortic valve has not been reported yet. Case presentation We experienced the case of a 56-year-old female patient presenting as aortic regurgitation resulted from malcoaptation of quadricupsid aortic valve. The patient had also accompanying aneurysmal ascending aortic dilatation and coronary ostial anomaly. Surgical correction (aortic valve replacement with mechanical devices and supracoronary aortic replacement with prosthetic graft) was performed without any complications. Conclusions The technological development of preoperative imaging studies enable the physician to encounter the quadricuspid aortic valve with other associated malformations more often unlike previous reports. With review on the quadricuspid aortic valve, we discussed a surgical considerations for the treatment of this anomaly. Electronic supplementary material The online version of this article (doi:10.1186/s13019-017-0622-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
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Song I, Park JA, Choi BH, Ko SM, Shin JK, Chee HK, Kim JS. Morphological and Functional Evaluation of Quadricuspid Aortic Valves Using Cardiac Computed Tomography. Korean J Radiol 2016; 17:463-71. [PMID: 27390538 PMCID: PMC4936169 DOI: 10.3348/kjr.2016.17.4.463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 04/12/2016] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). Materials and Methods We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. Results All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). Conclusion Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV.
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Affiliation(s)
- Inyoung Song
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jung Ah Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Bo Hwa Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Je Kyoun Shin
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Hyun Keun Chee
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jun Seok Kim
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
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Abstract
Background—
Quadricuspid aortic valve (QAV) is a rare congenital cardiac defect. This study sought to determine QAV frequency in a large echocardiography database, to characterize associated cardiovascular abnormalities, and to describe long-term outcomes.
Methods and Results—
Fifty patients (mean±SD age, 43.5±21.8 years at the time of the index diagnosis; female sex, 52%) received a diagnosis of QAV between January 1, 1975, and March 14, 2014 (frequency, 0.006%). The QAV was type A in 32% and type B in 32% (Hurwitz and Roberts classification). Aortic dilatation was present in 29% of the patients, and 26% had moderate or severe aortic valve regurgitation at the index diagnosis. Stenosis affected only 8% of the valves and was mild. Other findings, including abnormalities of other cardiac valves, septal defects, persistent left superior vena cava, and patent ductus arteriosus, were present in 32% of patients. During a mean±SD follow-up of 4.8±5.6 years, 8 patients underwent aortic valve surgery, with severe aortic valve regurgitation being the surgical indication in 7 patients. One patient with mild to moderate aortic valve regurgitation underwent aortic valve repair for obstruction of the left coronary ostium by the accessory cusp of QAV. No infective endocarditis or aortic dissection was found. Overall survival was 91.5% and 87.7% at 5 and 10 years.
Conclusions—
Aortic dilatation and other structural cardiac abnormalities were relatively common among patients with QAV. Aortic valve regurgitation was the predominant hemodynamic abnormality and the indication for aortic valve surgery in most patients who received surgery. Long-term survival was excellent.
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Massoni F, Ricci S. Death From Ascending Aortic Aneurysm Secondary to Quadricuspid Aortic Valve. Am J Forensic Med Pathol 2014; 35:232-3. [DOI: 10.1097/paf.0000000000000126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhu J, Zhang J, Wu S, Zhang Y, Ding F, Mei J. Congenital quadricuspid aortic valve associated with aortic insufficiency and mitral regurgitation. J Cardiothorac Surg 2013; 8:87. [PMID: 23587156 PMCID: PMC3648369 DOI: 10.1186/1749-8090-8-87] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/09/2013] [Indexed: 01/19/2023] Open
Abstract
Congenital quadricuspid aortic valve is a rare cardiac anomaly. More than half of the patients with this abnormality will develop aortic insufficiency in adulthood. It is vital that patients with quadricuspid aortic valve who present with progressive aortic regurgitation undergo valve replacement or repair at appropriate time. Here, we present two cases of quadricuspid aortic valve. We first describe a 58-year-old man who had mitral regurgitation and ascending aorta dilatation with quadricuspid aortic valve. He underwent aortic valve replacement and mitral valve plasty and recovered well. The second patient is a 20-year-old asymptomatic boy who has been closely followed up and has not received any surgical treatment.
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Affiliation(s)
- Jiaquan Zhu
- Cardiovascular Surgery Division, Cardiac Center, Shanghai Jiaotong University, Shanghai, China
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Jagannath AD, Johri AM, Liberthson R, Larobina M, Passeri J, Tighe D, Agnihotri AK. Quadricuspid Aortic Valve: A Report of 12 Cases and a Review of the Literature. Echocardiography 2011; 28:1035-40. [DOI: 10.1111/j.1540-8175.2011.01477.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Kasama K, Ogino H, Matsuda H, Minatoya K, Sasaki H, Tanaka H, Ishibashi-Ueda H, Kobayashi J. Ascending aortic aneurysm associated with a quadricuspid aortic valve. Gen Thorac Cardiovasc Surg 2011; 59:179-80. [DOI: 10.1007/s11748-010-0645-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Accepted: 05/18/2010] [Indexed: 11/30/2022]
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Tsukioka K, Nobara H, Takano T, Wada Y, Amano J. Quadricuspid Aortic Valve with Ascending Aortic Aneurysm: A Case Report and Histopathological Investigation. Ann Thorac Cardiovasc Surg 2011; 17:418-21. [DOI: 10.5761/atcs.cr.10.01567] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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