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Left atrial wall dissection after on-pump coronary surgery. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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2
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Halline C, Winegarner A, Maslow A, Gorgone M. Left Atrial Dissection Secondary to Retrograde Coronary Sinus Cannulation During a Stanford Acute Type-A Aortic Dissection Repair: A Case Report. A A Pract 2022; 16:e01568. [PMID: 35171844 PMCID: PMC8876416 DOI: 10.1213/xaa.0000000000001568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/21/2022]
Abstract
Left atrial (LA) dissections are rare phenomena, often iatrogenic, caused by blood flow into a false lumen, potentially obstructing the pulmonary veins or flow into the left ventricle. Severity can range from an incidental observation or complete circulatory collapse. While LA dissections are often associated with mitral valve repair, there are 2 reported cases of LA dissections associated with retrograde cardioplegia cannula insertion through the coronary sinus. Here, we present a large LA dissection that was directly visualized and tracked to a coronary sinus injury from the retrograde cardioplegia cannula. The clinical presentation and echocardiography findings informed our subsequent management.
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Affiliation(s)
- Christopher Halline
- From the Department of Anesthesiology, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Andrew Winegarner
- From the Department of Anesthesiology, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Andrew Maslow
- From the Department of Anesthesiology, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Michelle Gorgone
- From the Department of Anesthesiology, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
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Smith SP, Spear CR, Ryan PE, Stout DM, Youssef SJ, Hernandez RA, Barnhart GR, Lehr EJ. A Reproducible and Effective Technique for Coronary Sinus Injury Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:37-41. [PMID: 35023798 DOI: 10.1177/15569845211060350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Coronary sinus injury related to the use of a retrograde cardioplegia catheter is a rare but potentially life-threatening complication with mortality reported as high as 20%. We present a series of iatrogenic coronary sinus injuries as well as an effective method of repair without any ensuing mortality. Methods: There were 3,004 cases that utilized retrograde cardioplegia at our institution from 2007 to 2018. Of these, 15 patients suffered a coronary sinus injury, an incidence of 0.49%. A pericardial roof repair was performed in 14 cases in which autologous pericardium was sutured circumferentially to normal epicardium around the injury with purified bovine serum albumin and glutaraldehyde injected into the newly created space as a sealant. Incidence of perioperative morbidity and mortality, operative time, and length of stay were collected. Results: In our series, there were no intraoperative or perioperative mortalities. Procedure types included coronary artery bypass grafting (CABG), valve replacement and repair, or combined CABG and valve procedures. Median (interquartile range) cross-clamp time was 100 (88 to 131) minutes, cardiopulmonary bypass duration was 133 (114 to 176) minutes, and length of stay was 6 (4 to 8) days. None of the patients returned to the operating room for hemorrhage, and there were no complications associated with the repair of a coronary sinus injury when using the pericardial roof technique. Conclusions: Coronary sinus injuries can result in difficult to manage perioperative bleeding and potentially lethal consequences from cardiac manipulation. Our series supports the pericardial roof technique as an effective solution to a challenging intraoperative complication.
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Affiliation(s)
- Shane P Smith
- 187868Swedish Heart and Vascular Institute, Seattle, WA, USA
| | - Charlotte R Spear
- 12355West Virginia University School of Medicine, Morgantown, WV, USA
| | - Patrick E Ryan
- 187868Swedish Heart and Vascular Institute, Seattle, WA, USA
| | - David M Stout
- 187868Swedish Heart and Vascular Institute, Seattle, WA, USA
| | | | | | | | - Eric J Lehr
- 187868Swedish Heart and Vascular Institute, Seattle, WA, USA
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Nakahara Y, Kanemura T. Sutureless hemostasis of a coronary sinus rupture with Hydrofit. Indian J Thorac Cardiovasc Surg 2020; 36:512-514. [PMID: 33061164 DOI: 10.1007/s12055-020-00953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022] Open
Abstract
Coronary sinus rupture (CSR) is a rare operative complication, and a standard procedure for its treatment has not been established. We report successful repair of a CSR in a 68-year-old man who underwent total arch replacement for type A acute aortic dissection. CSR was caused by the coronary sinus cannulation for retrograde cardioplegia and was detected during cardiopulmonary bypass weaning. We applied an elastomeric sealant with a bovine pericardium patch on the beating heart. After manual compression for 2 min, complete hemostasis was achieved. A clampless and sutureless hemostasis for repairing coronary sinus rupture is a simple, fast, and effective technique.
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Affiliation(s)
- Yoshinori Nakahara
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo, 124-0006 Japan
| | - Takeyuki Kanemura
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo, 124-0006 Japan
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Kawago K, Yoshida Y, Shiraiwa S, Honda Y, Sakakibara K, Kaga S, Nakajima H. Pitfalls of Retrograde Cardioplegia Cannulation: Left Atrium Dissection. Ann Thorac Surg 2020; 110:e381-e384. [PMID: 32428434 DOI: 10.1016/j.athoracsur.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
Left atrial dissection is a rare complication of cardiac surgery. We present a case of left atrial dissection that occurred during a partial arch repair for Stanford acute type A aortic dissection. Because no entry was found in the left atrium by transesophageal echocardiography, and there were no issues weaning from cardiopulmonary bypass, we decided that no surgical intervention was necessary. Transthoracic echocardiography and computed tomography showed the remaining dissection on postoperative day 7; however, on postoperative day 14, it had completely disappeared.
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Affiliation(s)
- Koji Kawago
- 2nd Division, Department of Surgery, University of Yamanashi, Yamanashi, Japan.
| | - Yukiyo Yoshida
- 2nd Division, Department of Surgery, University of Yamanashi, Yamanashi, Japan
| | - Satoru Shiraiwa
- 2nd Division, Department of Surgery, University of Yamanashi, Yamanashi, Japan
| | - Yoshihiro Honda
- 2nd Division, Department of Surgery, University of Yamanashi, Yamanashi, Japan
| | - Kenji Sakakibara
- 2nd Division, Department of Surgery, University of Yamanashi, Yamanashi, Japan
| | - Shigeaki Kaga
- 2nd Division, Department of Surgery, University of Yamanashi, Yamanashi, Japan
| | - Hiroyuki Nakajima
- 2nd Division, Department of Surgery, University of Yamanashi, Yamanashi, Japan
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Nguyen TC. Commentary: Hemostatic patch for coronary sinus rupture: An efficient solution for a complicated problem? J Thorac Cardiovasc Surg 2018; 157:e193. [PMID: 30195599 DOI: 10.1016/j.jtcvs.2018.07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Tex.
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Panagiotopoulos N, Patrini D, Adams B, Lawrence D, Roberts N. A novel sutureless technique for the repair of coronary sinus injuries. J Thorac Dis 2016; 7:2359-61. [PMID: 26793359 DOI: 10.3978/j.issn.2072-1439.2015.12.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Coronary Sinus injury related to cardioplegia catheter insertion is a rare complication associated with significant morbidity and mortality risk. We describe a simple, safe and effective sutureless technique for the management of coronary sinus injury. This technique was developed in a porcine haemostatic workshop in Hamburg, Germany.
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Affiliation(s)
- Nikolaos Panagiotopoulos
- Department of Cardiothoracic Surgery, the Heart Hospital, University College London Hospitals (UCLH), London, UK
| | - Davide Patrini
- Department of Cardiothoracic Surgery, the Heart Hospital, University College London Hospitals (UCLH), London, UK
| | - Benjamin Adams
- Department of Cardiothoracic Surgery, the Heart Hospital, University College London Hospitals (UCLH), London, UK
| | - David Lawrence
- Department of Cardiothoracic Surgery, the Heart Hospital, University College London Hospitals (UCLH), London, UK
| | - Neil Roberts
- Department of Cardiothoracic Surgery, the Heart Hospital, University College London Hospitals (UCLH), London, UK
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Bali RK, Sharma P, Gaba S, Kaur A, Ghanghas P. A review of complications of odontogenic infections. Natl J Maxillofac Surg 2015; 6:136-43. [PMID: 27390486 PMCID: PMC4922222 DOI: 10.4103/0975-5950.183867] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Life-threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous sinus thrombosis, sepsis, thoracic empyema, Lemierre's syndrome, cerebral abscess, orbital abscess, and osteomyelitis. The incidence of these "space infections" has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. This study reviews complications of odontogenic infections. The search done was based on PubMed and Google Scholar, and an extensive published work search was undertaken. Advanced MEDLINE search was performed using the terms "odontogenic infections," "complications," and "risk factors."
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Affiliation(s)
- Rishi Kumar Bali
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Parveen Sharma
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Shivani Gaba
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Avneet Kaur
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Priya Ghanghas
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
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Martinelli SM, Berry J, Dalal N, Stansfield W, Moylan VJ, Kumar P. Left Atrial Dissection. Anesth Analg 2014; 119:1078-81. [DOI: 10.1213/ane.0000000000000449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fukuhara S, Dimitrova KR, Geller CM, Hoffman DM, Tranbaugh RF. Left atrial dissection: an almost unknown entity. Interact Cardiovasc Thorac Surg 2014; 20:96-100. [DOI: 10.1093/icvts/ivu317] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ito H, Saito S, Miyahara K, Takemura H, Mizutani S, Toyama M, Matsuura A. Retrograde cardioplegia revisited: open technique for long aortic cross clamping. Heart Lung Circ 2013; 22:742-5. [PMID: 23548336 DOI: 10.1016/j.hlc.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 02/13/2013] [Accepted: 03/01/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The efficacy of retrograde cardioplegia for myocardial protection is still controversial. In our institution, we exclusively use intermittent administration of tepid, undiluted blood supplemented with potassium and magnesium for the cases with aortic insufficiency, requiring aortotomy, or undergoing mitral valve repair. In using this retrograde technique, we make a point of cannulating a retrograde perfusion catheter under direct vision following right atriotomy. The purpose of this retrospective study is to evaluate the clinical outcome of using this technique. METHODS This study comprises 49 patients who underwent elective valve surgery using direct-vision retrograde cardioplegia exclusively, requiring more than 3h aortic cross-clamping. Their clinical outcome was reviewed retrospectively. RESULTS There was no hospital mortality in this study. No patient was noted to have evidence of mediastinitis, myocardial infarction, or cerebral complications in the postoperative period. The case requiring the longest aortic cross-clamping time (380 min) survived the operation without the use of intra-aortic balloon pumping or percutaneous cardiopulmonary support, and the postoperative course was uneventful. CONCLUSIONS Our result suggests that direct-vision retrograde cardioplegia is a safe and effective method of cardioplegia delivery, and provides a longer period of myocardial protection than previously thought.
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Affiliation(s)
- Hideki Ito
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558, Japan.
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Krishnan S, Papworth DP, Farivar RS, Ueda K. Identification of coronary sinus injury by transesophageal echocardiography during placement of a retrograde cardioplegia catheter for minimally invasive cardiac surgery. Anesth Analg 2013; 116:560-2. [PMID: 23400977 DOI: 10.1213/ane.0b013e31827bc352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sundar Krishnan
- Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52246, USA.
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Myocardial oxidative stress protection with sevoflurane versus propofol. Eur J Anaesthesiol 2012; 29:296-7; author reply 297-8. [PMID: 22343610 DOI: 10.1097/eja.0b013e328351660a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spontaneous Bacterial Pericarditis and Coronary Sinus Endocarditis Caused by Oxacillin-Susceptible Staphylococcus aureus. Case Rep Med 2010; 2010:984562. [PMID: 20585370 PMCID: PMC2878699 DOI: 10.1155/2010/984562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 04/08/2010] [Indexed: 01/30/2023] Open
Abstract
This paper describes a case of a 44-year-old male patient previously healthy admitted with an unusual spontaneous acute bacterial pericarditis associated with coronary sinus mass. Two-dimensional echocardiography showed large loculated pericardial effusion with signs of diastolic restriction and an image suggesting vegetation in topography of the right atrium coronary sinus. Pericardial drainage, coronary sinus vegetation resection, and antibiotic therapy with Oxacillin were performed due to Oxacillin-susceptible Staphylococcus aureus identified on the pericardial effusion and blood culture. This is a rare condition and a unique combination of a spontaneous acute bacterial pericarditis with coronary sinus endocarditis without cardiac valve compromise.
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LeVan P, Stevenson J, Develi N, Frey K. Cardiovascular Collapse After Femoral Venous Cannula Placement for Robotic-Assisted Mitral Valve Repair and Patent Foramen Ovale Closure. J Cardiothorac Vasc Anesth 2008; 22:590-1. [DOI: 10.1053/j.jvca.2007.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Indexed: 11/11/2022]
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Agrifoglio M, Barili F, Kassem S, Dainese L, Parolari A, Pontone G, Polvani G, Alamanni F, Biglioli P. Sutureless patch-and-glue technique for the repair of coronary sinus injuries. J Thorac Cardiovasc Surg 2007; 134:522-3. [PMID: 17662808 DOI: 10.1016/j.jtcvs.2007.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 03/15/2007] [Accepted: 04/19/2007] [Indexed: 11/21/2022]
Affiliation(s)
- Marco Agrifoglio
- Department of Cardiac Surgery, Centro Cardiologico Monzino, University of Milan, Milan, Italy
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Aigner C, Wolner E, Mohl W. Management of central coronary sinus ruptures using the pericardial patch repair technique. Ann Thorac Surg 2006; 81:1275-8. [PMID: 16564257 DOI: 10.1016/j.athoracsur.2005.11.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 11/10/2005] [Accepted: 11/22/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intraoperative coronary sinus rupture is a rare event; however, it carries potential mortality and its' management is technically challenging. A repair technique should provide adequate bleeding control while avoiding narrowing or stricture of the coronary sinus. METHODS We retrospectively review our experience with a new pericardial patch repair technique. From January 1996 to May 2005 four cases of intraoperative coronary sinus injury were identified. Three female patients and one male patient with a mean age of 74 +/- 4 years underwent valve replacement and/or coronary artery bypass on cardiopulmonary bypass. A double pericardial patch technique sandwiched with human fibrin glue was used to cover the defect. RESULTS In all patients treated with this method, the injury could be treated successfully. All patients were extubated on the first postoperative day and median intensive care unit stay was 3 days. Drains could be removed after 4 days median. Median hospital stay was 13 days. After a median follow-up of 33 months all patients are alive without any echocardiographic signs of impairments of the coronary sinus. CONCLUSIONS We conclude that the pericardial patch technique is a safe and technically feasible technique for repair of central coronary sinus ruptures. Excellent bleeding control and, in our experience, no consecutive complications were observed.
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Affiliation(s)
- Clemens Aigner
- Department of Cardio-Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Abstract
The use of retrograde cardioplegia is a safe, effective and widespread method for myocardial protection in a broad range of cardiac procedures. Retrograde cardioplegia may be delivered retrograde alone or, most frequently, in combination with an antegrade way of delivery. However, the degree of myocardial protection provided by retrograde cardioplegia may vary due to anatomic differences or for other reasons.
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Affiliation(s)
- Wolfgang Bothe
- Department of Cardiovascular Surgery, University Hospital Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany
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