Slings and rings

  • Antonio F. Corno


In this chapter the two most frequent anatomical situations with slings and/or rings are taken into considerations: pulmonary artery sling and vascular ring.


Pulmonary Artery Aortic Arch Patent Ductus Arteriosus Main Pulmonary Artery Left Pulmonary Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Adler SC, Isaacson G, Balsara RK (1995) Innominate artery compression of the trachea: diagnosis and treatment by anterior suspension. A 25-year experience. Ann Otol Rhinol Laryngol 104:924PubMedGoogle Scholar
  2. Anand R, Dooley KJ, Williams WH, Vincent RN (1994) Follow-up of surgical correction of vascular anomalies causing tracheobronchial compression. Pediatr Cardiol 15:58–61PubMedGoogle Scholar
  3. Angelini A, Dimopoulos K, Frescura C, Gamba P, Lo Piccolo R, Stellin G, Thiene G (2002) Fatal aortoesophageal fistula in two cases of tight vascular ring. Cardiol Young 12:172–176PubMedGoogle Scholar
  4. Arciniegas E, Hakimi M, Hertzler JH, Farooki ZQ, Green EW (1979) Surgical management of congenital vascular rings. J Thorac Cardiovasc Surg 77:721–727PubMedGoogle Scholar
  5. Ardito JM, Tucker GF, Ossof RH, Dileon SY (1980) Innominate artery compression of the trachea in infants with reflux apnea. Ann Otol Rhinol Laryngol 89:401–405PubMedGoogle Scholar
  6. Arkin A (1936) Double aortic arch with total persistence of the right and isthmus stenosis of the left: a new clinical and X-ray picture. Report of six cases in adults. Am Heart J 11:44–74Google Scholar
  7. Backer CL, Ilbawi MN, Idriss FS, De Leon SY (1989) Vascular anomalies causing tracheoesophageal compression: review of expression in children. J Thorac Cardiovasc Surg 97:725–731PubMedGoogle Scholar
  8. Backer CL, Idriss FS, Holinger LD, Mavroudis C (1992) Pulmonary artery sling: results of surgical repair. J Thorac Cardiovasc Surg 103:683–691PubMedGoogle Scholar
  9. Backer CL, Holinger LD, Mavroudis C (1992) Innominate artery compression: division and reimplantation versus suspension. J Thorac Cardiovasc Surg 103:817PubMedGoogle Scholar
  10. Backer CL, Mavroudis C, Dunham ME (1999) Pulmonary artery sling: results with median sternotomy, cardiopulmonary bypass, and reimplantation. Ann Thorac Surg 67:1738PubMedGoogle Scholar
  11. Baumann JL, Ward BH, Woodrum DE (1977) Aberrant left pulmonary artery: clinical and embryonic factors. Chest 72:67–71Google Scholar
  12. Berdon WE, Baker DH (1972) Vascular anomalies and the infants lung: rings, slings and other things. Semin Roentgenol 7:39–64PubMedGoogle Scholar
  13. Berman W, Yabec SM, Dillion T, Neal JF, Bechara A, Burstein J (1981) Vascular ring due to left aortic arch and right descending aorta. Circulation 63:458–460PubMedGoogle Scholar
  14. Bertolini A, Pelizza A, Panizzon G (1987) Vascular rings and slings: diagnosis and surgical treatment of 49 patients. J Cardiovasc Surg 28:301–312Google Scholar
  15. Bertrand JM, Chartrand C, Lamarre A, Lapierre JG (1986) Vascular ring: clinical and physiological assessment of respiratory function following surgical correction. Pediatr Pulmonol 2:378–383PubMedGoogle Scholar
  16. Bisset GS, Strife JL, Kirks DR, Bailey WW (1987) Vascular rings: MR imaging. Am J Radiol 149: 251–256Google Scholar
  17. Blair GK, Cohen R, Filler RM (1986) Treatment of tracheomalacia: eight years’ experience. J Pediatr Surg 21:781–785PubMedGoogle Scholar
  18. Bonnard A, Auber F, Fourcade L, Marchac V, Emond S, Revillon Y (2003) Vascular ring abnormalities: a retrospective study of 62 cases. J Pediatr Surg 38:539–543PubMedGoogle Scholar
  19. Bove T, Demanet H, Casimir G, Viart P, Goldstein JP, Deuvert FE (2001) Tracheobronchial compression of vascular origin: review of experience in infants and children. J Cardiovasc Surg 42:663–666Google Scholar
  20. Burke RP, Chang AC (1993) Video-assisted thoracoscopic division of a vascular ring in an infant: a new operative technique. J Card Surg 8:537–540PubMedGoogle Scholar
  21. Burke RP, Rosenfeld HM, Wernovsky G, Jonas RA (1995) Video-assisted thoracoscopic vascular ring division in infants and children. J Am Coll Cardiol 25:943–947PubMedGoogle Scholar
  22. Burrows PE, Moes CAF, Freedom RM (1986) Double aortic arch with atretic right dorsal segment. Pediatr Cardiol 6:331–334PubMedGoogle Scholar
  23. Capitanio MA, Ramo R, Kirkpatrick JA (1971) Pulmonary sling. Am J Radiol 112:28–34Google Scholar
  24. Chen HM, Chiu IS, Chen SJ, Wu SJ, Chan CH (2000) Concomitant management of airways and its adjacent vascular pathology in addition to repair of congenital cardiac defects. Int J Cardiol 73:181–189PubMedGoogle Scholar
  25. Chun K, Colombani PM, Dudgeon DL, Haller JA (1992) Diagnosis and management of congenital vascular rings: a 22-year experience. Ann Thorac Surg 53:597–602PubMedGoogle Scholar
  26. Cohen SR, Landing BH (1976) Tracheostenosis and bronchial anomalies associated with pulmonary artery sling. Ann Otol Rhinol Laryngol 85:582–590PubMedGoogle Scholar
  27. Conte S, Farina G, Caianello G, Palme G, Pisacane C, Mansi N, Vosa C (2003) Repair of pulmonary artery sling by reimplantation without cardiopulmonary bypass. Thorac Cardiovasc Surg 51:101–113PubMedGoogle Scholar
  28. Cornali M, Reginato E, Azzolina G (1976) Cervical aortic arch and a new type of double aortic arch: report of a case. Br Heart J 38:993–996PubMedGoogle Scholar
  29. Corno AF, Giamberti A, Giannico S, Marino B, Rossi E, Marcelletti C, Kirklin JK (1990) Airway obstruction associated with congenital heart disease in infancy. J Thorac Cardiovasc Surg 99:1091–1098PubMedGoogle Scholar
  30. Corno AF, Monnier Ph, von Segesser LK (2001) Tracheal resection associated with slide tracheoplasty for long-segment congenital tracheal stenosis involving the carina. J Thorac Cardiovasc Surg 122:403–404PubMedGoogle Scholar
  31. DiCruz IA, Cantiz T, Namin EP, Licata R, Hastreiter AR (1966) Right-sided aorta: part II. Right aortic arch, right descending aorta, and associated anomalies. Br Heart J 28:722–739Google Scholar
  32. Edwards JE (1948) Retroesophageal segment of the left aortic arch, right ligamentum arteriosum and right descending aorta causing a congenital vascular ring about the trachea and esophagus. Mayo Clin Proc 23:108–116Google Scholar
  33. Eklof O, Ekstrom G, Eriksson BO (1971) Arterial anomalies causing compression of the trachea and/or the oesophagus: a report of 30 symptomatic cases. Acta Paediat Scand 60:81–89PubMedGoogle Scholar
  34. Ergin MA, Jayaram N, LaCorte M (1981) Left aortic arch and right descending aorta: diagnostic and therapeutic implications of a rare type of vascular ring. Ann Thorac Surg 31:82–85PubMedGoogle Scholar
  35. Ericsson NO, Soderlund S (1969) Compression of the trachea by an anomalous innominate artery. J Pediatr Surg 4:424–431PubMedGoogle Scholar
  36. Fearon B, Shortreed R (1963) Tracheobronchial compression by congenital cardiovascular anomalies in children: syndrome of apnea. Ann Otol Rhinol Laryngol 72:949–970PubMedGoogle Scholar
  37. Feingold B, O’Sullivan B, del Nido P, Pollack P (2001) Situs inversus totalis and corrected transposition of the great arteries [I,D,D] in association with a previously unreported vascular ring. Pediatr Cardiol 22:338–342PubMedGoogle Scholar
  38. Fleenor JT, Weinberg PM, Kramer SS, Fogel M (2003) Vascular rings and their effect on tracheal geometry. Padiatr Cardiol 24:430–435Google Scholar
  39. Fletcher BD, Cohen RC (1989) Tracheal compression and the innominate artery: MR evaluation in infants. Radiology 170:103–107PubMedGoogle Scholar
  40. Garabedian EN, Le Bret E, Corre A, Roger G, Pineau E, Bourel P, Folliguet T, Vouhé PR, Laborde F (2001) Tracheal resection associated with slide tracheoplasty for long-segment congenital tracheal stenosis involving the carina. J Thorac Cardiovasc Surg 121:393–395PubMedGoogle Scholar
  41. Gerlis LM, Anderson RH (2001) Unusual origin and course of the left pulmonary artery. Clin Anat 14:373–378PubMedGoogle Scholar
  42. Gil-Jaurena JM, Murtra M, Goncalves A, Miro L (2002) Aortic coarctation, vascular ring, and right aortic arch with aberrant subclavian artery. Ann Thorac Surg 73:1640–1642PubMedGoogle Scholar
  43. Goldman SA, Rimell FL, Meza MP, Newman B (1997) Diagnosis and management of left main stem bronchus compression. Ann Otol Rhinol Laryngol 106:461–465PubMedGoogle Scholar
  44. Gomes AS, Lois JF, George B, Alpan G, Williams RG (1987) Congenital abnormalities of the aortic arch: MR imaging. Radiology 165:691–695PubMedGoogle Scholar
  45. Greiner A, Perkmann R, Rieger M, Neuhauser B, Fraedrich G (2003) Vascular ring causing tracheal compression in an adult patient. Ann Thorac Surg 75:1959–1960PubMedGoogle Scholar
  46. Grillo HC (1994) Slide tracheoplasty for long-segment congenital tracheal stenosis. Ann Thorac Surg 58:613PubMedGoogle Scholar
  47. Gross RE (1945) Surgical relief for tracheal obstruction from a vascular ring. N Engl J Med 233:586PubMedGoogle Scholar
  48. Gross RE, Neuhauser EBD (1951) Compression of the trachea or esophagus by vascular anomalies: surgical therapy in 40 cases. Pediatrics 7:69–88PubMedGoogle Scholar
  49. Han JJ, Sohn S, Kim HS, Won TH, Ahn JH (2001) A vascular ring: right aortic arch and descending aorta with left ductus arteriosus. Ann Thorac Surg 71:729–731PubMedGoogle Scholar
  50. Haramati LB, Glickstein JS, Issenberg HJ, Haramati N, Crooke GA (2002) MR imaging and CT of vascular anomalies and connections in patients with congenital heart disease: significance in surgical planning. Radiographics 22:337–347PubMedGoogle Scholar
  51. Hartyanszky IL, Lozsadi K, Marcsek P, Huttl T, Sapi E, Kovacs AB (1989) Congenital vascular rings: surgical management of 111 cases. Eur J Cardiothorac Surg 3:250–254PubMedGoogle Scholar
  52. Hastreiter AR, DiCruz IA, Cantiz T (1966) Rightsided aorta: part I. Occurrence of right aortic arch in various types of congenital heart disease. Br Heart J 28:675–681Google Scholar
  53. Hawkins JA, Bailey WW, Clark SM (1992) Innominate artery compression of the trachea: treatment by reimplantation of the innominate artery. J Thorac Cardiovasc Surg 103:678PubMedGoogle Scholar
  54. Heck HA, Moore HV, Lutin WA, Leatherbury L, Truemper EJ, Steinhart CM, Pearson-Shaver AL (1993) Esophageal-aortic erosion associated with double aortic arch and tracheomalacia: experience with 2 infants. Tex Heart Inst J 20:126–129PubMedGoogle Scholar
  55. Herrera MA, DiSouza VJ, Link KM, Weesner KM, Formanek AG (1987) A persistent fifth aortic arch in man: a double-lumen aortic arch (presentation of a new case and review of the litarature). Pediatr Cardiol 8:265–269PubMedGoogle Scholar
  56. Hishitani T, Ogawa K, Hoshino K, Ono H, Urashima T, Yoshitake M, Ko Y, Nakamura Y, Iwanaka T, Suzuki M (2001) Usefulness of continuous monitoring of airway resistance and flow-volume curve in the perioperative management of infants with central airway obstruction: a case of vascular ring. J Thorac Cardiovasc Surg 122:1229–1233PubMedGoogle Scholar
  57. Hodina M, Wicky S, Payot M, Sekarski N, Gudinchet F (2001) Non-invasive imaging of the ring-sling complex in children. Pediatr Cardiol 22:333–337PubMedGoogle Scholar
  58. Jeong DH, Han HS, Hahn YS, Lee SJ (2000) Unusual association of pulmonary artery sling with right aortic arch and aberrant left subclavian artery. J Korean Med Sei 15:119–121Google Scholar
  59. Jones DT, Jonas RA, Healy GB (1994) Innominate artery compression of the trachea. Ann Otol Rhinol Laryngol 103:347PubMedGoogle Scholar
  60. Kan MN, Nanda NC, Stopa AR (1987) Diagnosis of double aortic arch by cross-sectional echocardiography with Doppler colour-flow mapping. Br Heart J 58:284–286PubMedGoogle Scholar
  61. Knight I, Edwards JE (1974) Right aortic arch: types and associated anomalies. Circulation 50:1047–1051PubMedGoogle Scholar
  62. Kocis KC, Midgley FM, Ruckman RN (1997) Aortic arch complex anomalies: 20-year experience with symptoms, diagnosis, associated cardiac defects, and surgical repair. Pediatr Cardiol 18:127–132PubMedGoogle Scholar
  63. Koopot R, Nikaidoh H, Idriss FS (1975) Surgical management of anomalous left pulmonary artery causing tracheobronchial obstruction. Pulmonary artery sling. J Thorac Cardiovasc Surg 69:239PubMedGoogle Scholar
  64. Lang FJ, Hurni M, Monnier P (1999) Long-segment congenital tracheal stenosis: treatment by slide-tracheoplasty. J Pediatr Surg 34:1216–1222PubMedGoogle Scholar
  65. Lee SL, Cheung YF, Leung MP, Ng YK, Tsoi NS (2002) Airway obstruction in children with congenital heart disease: assessment by flexible bronchoscopy. Pediatr Pulmonol 34:304–311PubMedGoogle Scholar
  66. Leijala M, Sairanen H, Makinen L, Maunuksela EL, Louhimo I (1989) Iatrogenic, unexpected and other vascular rings in children. Eur J Cardiothorac Surg 3:125–129PubMedGoogle Scholar
  67. Lenox CC, Crisler C, Zuberbuhler JR, Park SC, Neches WH, Mathews RA, Fricker FJ, Golding LA (1979) Anomalous left pulmonary artery: successful management. J Thorac Cardiovasc Surg 77:748–752PubMedGoogle Scholar
  68. Lillehei CW, Colan S (1992) Echocardiography in the preoperative evaluation of vascular rings. J Pediatr Surg 27:1118–1120PubMedGoogle Scholar
  69. Lincoln JCR, Deverall PB, Stark J, Aberdeen E, Waterston DJ (1969) Vascular anomalies compres? sing the oesophagus and trachea. Thorax 24:295–304PubMedGoogle Scholar
  70. Lowe GM, Donaldson JS, Backer CL (1991) Vascular rings: 10-year review of imaging. Radiographics 11:637PubMedGoogle Scholar
  71. Lubbers WJ, Tegelaers WHH, Losekoot TG (1975) Aberrant origin of the left pulmonary artery (vascular sling): report of the clinical and anatomic features in three patients. Eur J Cardiol 2:477–484PubMedGoogle Scholar
  72. McElhinney DB, Reddy VM, Pian MS, Moore P, Hanley FL (1999) Compression of the central airways by a dilated aorta in infants and children with congenital heart disease. Ann Thorac Surg 67:1130–1136PubMedGoogle Scholar
  73. McElhinney DB, Thompson LD, Weinberg PM, Jue KL, Hanley FL (2000) Surgical approach to complicated cervical aortic arch: anatomic, developmental, and surgical considerations. Cardiol Young 10:212–219PubMedGoogle Scholar
  74. McElhinney DB, Hoydu AK, Gaynor JW, Spray TL, Goldmuntz E, Weinberg PM (2001) Patterns of right aortic arch and mirro-image branching of the brachiocephalic vessels without associated anomalies. Pediatr Cardiol 22:285–291PubMedGoogle Scholar
  75. McElhinney DB, Clark BJ, Weinberg PM, Kenton ML, McDonald-McGinn D, Driscoll DA, Zackai EH, Goldmuntz E (2001) Association of chromosome 22qll deletion with isolated anomalies of aortic arch laterality and branching. J Am Coll Cardiol 37:2114–2119PubMedGoogle Scholar
  76. McFaul R, Millard P, Nowicki E (1981) Vascular rings necessitating right thoracotomy. J Thorac Cardiovasc Surg 82:306–309PubMedGoogle Scholar
  77. McKay R, Stark J, de Levai MR (1982) Unusual vascular ring in infant with pulmonary atresia and ventricular septal defect. Br Heart J 48:180–183PubMedGoogle Scholar
  78. Mihaljevic T, Cannon JW, del Nido PJ (2003) Robotically assisted division of a vascular ring in children. J Thorac Cardiovasc Surg 125:1163–1164PubMedGoogle Scholar
  79. Moes CAF, Izukawa T, Trusler GA (1975) Innominate artery compression of the trachea. Arch Otolaryngol 101:733–738PubMedGoogle Scholar
  80. Moodie DS, Yiannikas J, Gill CC, Buonocore E, Pavlick W (1982) Intravenous digital subtraction angiography in the evaluation of congenital anomalies of the aorta and aortic arch. Am Heart J 104:628–634PubMedGoogle Scholar
  81. Morel V, Corbineau H, Lecoz A, Verhoye JP, Heautot JF, Bassen R, Delavai P, Desrues B ((2002) Two cases of “asthma” revealing a diverticulum of Kommerell. Respiration 69:456–460PubMedGoogle Scholar
  82. Mossad E, Farid I, Youssef G, Ando M (2002) Diverticulum of Kommerell: a review of a series and a report of a case with tracheal deviation compromising single lung ventilation. Anesth Analg 94:1462–1464PubMedGoogle Scholar
  83. Murdison KA, Andrews BAA, Chin AJ (1990) Ultrasonographic display of complex vascular rings. J Am Coll Cardiol 15:1645PubMedGoogle Scholar
  84. Murthy K, Mattioli L, Diehl AM, Holder TM (1970) Vascular ring due to left aortic arch, right descending aorta, and right patent ductus arteriosus. J Pediatr Surg 8:550–554Google Scholar
  85. Neuhauser EDB (1946) The roentgen diagnosis of double aortic arch and other anomalies of the great vessels. Am J Roentgenol Rad Ther Nucl Med 56:1–12Google Scholar
  86. Niwayama G (1960)Unusual vascular ring formed by the anomalous left pulmonary artery with tracheal compression. Am Heart J 59:454PubMedGoogle Scholar
  87. Ozkan M, Dogan R, Demircin M, Ersoy U, Boke E, Pasaoglu I (2003) Vascular anomalies causing tracheoesophageal compression: a 20-year experience in diagnosis and management. Heart Surg Forum 6:149–152PubMedGoogle Scholar
  88. Park SC, Siewers RD, William NH, Lenox C, Zuberbuhler JR (1976) Left aortic arch with right descending aorta and right ligamentum arteriosum. J Thorac Cardiovasc Surg 71:779–784PubMedGoogle Scholar
  89. Pawade A, de Levai MR, Elliott MJ, Stark J (1992) Pulmonary artery sling. Ann Thorac Surg 54:967PubMedGoogle Scholar
  90. Pickhardt PJ, Siegel MJ, Gutierrez FR (1997) Vascular rings in symptomatic children: frequency of chest radiographic findings. Radiology 203:423PubMedGoogle Scholar
  91. Philip S, Chen SY, Wu MH, Wang JK, Lue HC (2001) Retroesophageal aortic arch: diagnostic and therapeutic implications of a rare vascular ring. Int J Cardio 79:133–141Google Scholar
  92. Potts WJ, Gibson S, Rothwell R (1948) Double aortic arch: report of two cases. Arch Surg 57:227PubMedGoogle Scholar
  93. Potts WJ, Holinger PH, Rosenblum AH (1954) Anomalous left pulmonary artery causing obstruction to the right main stem bronchus. JAMA 155:1409Google Scholar
  94. Rimell FL, Shapiro AM, Meza MP, Goldman S, Hite S, Newman B (1997) Magnetic resonance imaging of the pediatric airway. Arch Otolaryngol Head Neck Surg 123:999–1003PubMedGoogle Scholar
  95. Sade RM, Rosenthal A, Fellows EK, Castaneda AR (1975) Pulmonary artery sling. J Thorac Cardiovasc Surg 69:333–346PubMedGoogle Scholar
  96. Sebening C, Jakob H, Tochtermann U, Lange R, Vahl CF, Bodegom P, Szabo G, Fleischer F, Schmidt K, Zilow E, Springer W, Ulmer HE, Hagl S (2000) Vascular tracheobronchial compression syndromes: experience in surgical treatment and literature review. Thorac Cardiovasc Surg 48:164–174PubMedGoogle Scholar
  97. Semple MG, Bricker L, Shaw BN, Pilling DW (2003) Left pulmonary artery sling presenting as unilateral echogenic lung on 20-week detailed antenatal ultrasound examination. Pediatr Radiol 33:567–569PubMedGoogle Scholar
  98. Shapiro NL, Huang RY, Sangwan S, Willner A, Laks H (2000) Tracheal stenosis and congenital heart disease in patients with Down syndrome: diagnostic approach and surgical options. Int J Pediatr Otorhinolaryngol 54:137–142PubMedGoogle Scholar
  99. Singer SJ, Fellows EK, Jonas RA (1988) Double aortic arch with bilateral coarctations. Am J Cardiol 61:196–197PubMedGoogle Scholar
  100. Swischuk LE (1971) Anterior tracheal indentation in infancy and childhood: normal or abnormal. Am J Radiol 112:12–17Google Scholar
  101. Tesler UF. Balsara RH, Niguidula FN (1974) Aberrant left pulmonary artery (vascular sling): report of five cases. Chest 66:402–407PubMedGoogle Scholar
  102. Tonkin IL, Gold RE, Moser D, Foster RE (1984) Evaluation of vascular rings with digital subtraction angiography. Am J Radiol 142:1287–1291Google Scholar
  103. Van Son JA; Julsrud PR, Hagler DJ, Sim EK, Puga FJ, Schaff HV, Danielson GK (1994) Imaging strategies for vascular rings. Ann Thorac Surg 57:604–610PubMedGoogle Scholar
  104. Vazquez-Jimenez JF, Sachweh JS, Liakopoulos OJ, Hugel W, Holzi J, von Bernuth G, Messmer BJ (2001) Aortopexy in severe tracheal instability: short-term and long-term outcome in 29 infants and children. Ann Thorac Surg 72:1898–1901PubMedGoogle Scholar
  105. Wittenberger MH, Gyepes MT, Crocker D (1967) Tracheal dynamics with respiratory distress, stridor and collapsing trachea. Radiology 88:653–662Google Scholar
  106. Woods RK, Sharp RJ, Holcomb GW, Snyder CL, Lofland GK, Ashcraft KW, Holder TM (2001) Vascular anomalies and tracheoesophageal compression: a single institution’s 25-year experience. Ann Thorac Surg 72:434–438PubMedGoogle Scholar
  107. Wychulis AR, Kincaid OW, Danielson GK (1971) Congenital vascular ring: surgical considerations and results of operation. Mayo Clin Proc 46:182–188PubMedGoogle Scholar
  108. Zachary CH, Myers JL, Eggli KD (2001) Vascular ring due to right aortic arch with mirror-image branching and left ligamentum arteriosus: complete preoperative diagnosis by magnetic resonance imaging. Pediatric Cardiol 22:71–73Google Scholar

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© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • Antonio F. Corno
    • 1
  1. 1.Department of Cardiovascular SurgeryCentre Hospitalier Universitaire Vaudois (CHUV)LausanneSwitzerland

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