Patient life after angioplasty and stent replacement

Angioplasty is a minimally-invasive surgical procedure performed to restore the optimum blood flow to the heart by removing the blockage from the artery, widening the artery for smooth flow, and ensuring optimal heart health. A blocked or narrowed artery can cause a heart attack and hence, this procedure is performed to restore the proper supply of blood and oxygen to the heart.

Also commonly known as balloon angioplasty, coronary angioplasty is the most widely opted for a course of treatment to avoid major surgery. In coronary angioplasty, the doctor again inserts a thin, fine tube called a catheter mounted with a tiny balloon into the blocked artery through an incision in the arm or groin. Once the catheter is in the right spot, the tiny balloon is inflated to remove the blockage from the artery and clear the passage to allow blood flow by pushing the plaque build-up to the walls of the artery. 

Stent Placement

Post angioplasty, once the blood supply is regulated the balloon is deflated and removed from the body. After this, sometimes the doctors’ place a stainless steel mesh is known as a stent in the heart to ensure the arteries do not clog again. Some stents are also medically coated to avoid narrowing of the arteries in future. These stents are placed on top of the balloon on the catheter, such as that upon the opening of the balloon, the stent opens up and reinforces the walls of the artery.

Both angioplasty and stent placement are very critical surgical procedures, which need utmost after-care and management. Post the procedure, the recovery period would be long and one must let the body regain strength slowly and steadily. Make steady improvements each day but never pressurise the heart in any condition. Consult the doctor about the involvement in physical activities.

To ensure the heart is healthy and functioning properly after the procedures, one must make certain strict lifestyle amendments and modifications, such as:

No Smoking: Life after an angioplasty and stent placement will strictly involve any smoking. Smoking damages the lining of the arteries causing fat to build up, which ultimately leads to narrowing of the artery and hampering of the flow of blood in the body. Not just smokers but even non-smokers are highly subject to developing heart diseases due to prolonged exposure to smoke.

Regular Medications: Once the angioplasty and stent placement is done, the doctor will advise certain medications to enhance the recovery of the heart and regain its strength. It is very critical to ensure that no dosages of the medicines are missed. These medications could include blood thinners (to restore blood flow), thrombolytics (to dissolve clots), nitroglycerin (to widen blood vessels), antiplatelet (to prevent new clots), and pain killers (to cub the pain). During the intake of these medicines, the body might experience a few negligible changes such as sensitivity to bruise easily, longer bleeding from clots, etc. 

Healthy Diet: After angioplasty and stent placement, there need to be some strict changes in the diet. Unhealthy foods that are high on cholesterol, sodium, trans fat, saturated fat, etc. should be avoided. Instead, foods such as green leafy vegetables, fish, whole grains, seeds, low-fat dairy, dry-fruits, fibre, etc. should be consumed and fit into the regular diet. Also, the diet should be full of nutrition.

Easy Physical Activity: One of the major causes of a heart problem is physical inactivity; hence, once the heart problem is cured via angioplasty and stent placement, the physical activity needs to improve. However, no strenuous workouts should be undertaken; only low-to-moderate physical activities such as walk should be assumed. Remember to not lift anything heavier than 10 pounds up until six weeks of angioplasty and stent placementOne can also resume sexual activity post consultation with the doctor and depending on the situation.

Lowering Stress: Once done with angioplasty and stent placement, one could practise yoga, meditation or increase involvement in hobbies to reduce overall stress and maintain heart health. It is necessary to manage stress after angioplasty and stent placement because stress is also another factor responsible for a heart problem. Stress increases heart rate and also shuffles the blood pressure, causing a lot of damage to the arteries. 

Healthy Weight: Post thesurgical procedures, management of weight become very critical to maintaining a healthy heart. Obesity is one of the major reasons for cardiac arrest and needs to be completely sorted. Soft workouts each day, healthy eating, controlled calories intake, nutritional food should be adapted to maintain a healthy weight.

Limited Alcohol Intake: Life after angioplasty and stent placement will not allow excessive alcohol. Strict limitations need to be put upon the quantity of alcohol consumed. Excessive alcohol consumption increases the chances of high blood pressure, cardiomyopathy, stroke, irregular heartbeats, etc. Too much alcohol is also a contributor to obesity, alcoholism and more. All of which could trigger the heart problem again.

Follow-up tests: Another very important factor that needs to be followed strictly after angioplasty and stent placement is to have regular check-ups to keep an eye on blood sugar levels, cholesterol levels, blood sugar levels, etc.

Overall, life after angioplasty and stent placement is not gloomy. It is another chance at life and one that needs attentive care and strict modifications in lifestyle. 

Risks associated with heart bypass surgery

Heart bypass surgery, also known as coronary artery bypass grafting (CABG) is a surgical procedure to improve poor blood flow to the heart caused by narrowing or blocking of arteries due to build-up of plaque. These arteries called coronary arteries are blood vessels responsible for supplying blood, oxygen and nutrients to the heart tissue. When these arteries are blocked or narrowed due to accumulation of plaque – fatty material within the walls of the arteries – the heart is restricted or limited of supply of oxygen-rich blood, causing severe symptoms including a heart attack in severe cases. This plaque is formed in the arteries when the inner walls of the arteries are damaged or injured due to several factors such as unhealthy diet, smoking, high blood pressure, high cholesterol, diabetes, and a sedentary lifestyle. This plaque – a build-up of fat, cholesterol, calcium, and other substances – tends to stick to the inner walls of the arteries, restricting the blood flow and thereby causing a system malfunction. 

Factors that increase the chances of a blockage or narrowing in the arteries include:

  • Increasing age
  • Sex – Men are more prone than women
  • Family history of heart disease or problems
  • Smoking
  • High blood pressure
  • High cholesterol level
  • Diabetes
  • Overweight or obesity
  • Physical inactivity
  • High stress
  • Unhealthy diet

A heart bypass surgery redirects the blood flow to the narrowed or blocked artery by using healthy blood vessels from the leg veins, arm or chest and connecting them with the blood vessels that are beyond the blocked or narrowed artery – causing a bypass for the compromised artery to relive the blood flow as a new passage can supply oxygen-rich blood to the blocked area. Depending on the severity of the case, one or more blood vessels may be used to bypass the affected artery. In one case, four major blocked arteries can be bypassed at once. 

A heart bypass surgery is a very successful surgical procedure and one of the prime methods used to correct blockages, leakages or narrowing of the coronary arteries. It is an open surgery also popularly known as bypass surgery, coronary artery bypass surgery or coronary artery bypass grafting.

Types of Heart Bypass Surgery

Traditional Heart Bypass Surgery: This is the most common methods used to treat blockages of the main artery by opening the chest bone to access the heart and stop it to connect it to a heart-lung bypass machine. This machine keeps supplying blood and oxygen to the tissue to keep the heart alive, meanwhile allowing the surgeon to relieve the blockage. Post the surgery, blood flow is restored and the heart starts beating properly.

Off-pump Heart Bypass Surgery: This is similar to a traditional coronary artery surgery, the heart is accessed via an incision in the chest bone but it is not stopped and neither is placed on a bypass machine, instead the blockage is treated on the beating heart.

Minimally-invasive Heart Bypass Surgery: A fairly new but minimally invasive procedure that uses several small incisions on the left side of the chest, between the ribs to access the heart instead of a large cut in the chest bone. This procedure primarily restores blood flow to the blood vessels in front of the heart. However, it is not effective in severe cases or cases that have more than one or two blocked or narrowed arteries.

Why is it done?

A heart bypass surgery or coronary artery bypass grafting may be done if you have a blocked artery causing symptoms such as:

  • Severe chest pain
  • Shortness of breath
  • Fatigue
  • Abnormal heart rhythm
  • Swollen hands and feet
  • Severe indigestion
  • Palpitations

However, in many cases there might not be any symptoms due to the initial stage; however, eventually with the increased build-up of plaque and blockage, symptoms will tend to show. In some cases, the symptoms are very last minute and often result in a heart attack and if the blood flow is not restored to the affected area within a stipulated time, the heart tissue will die, causing death. 

A doctor might also recommend a heart bypass surgery in the below cases:

  • When there is more than one compromised artery causing the left chamber of the heart to dysfunction
  • When the main artery in the left chamber of the heart is the affected one
  • When there is acute chest pain even while light physical work because of several artery blockages
  • When procedures such as angioplasty (removal of blockage through inflated balloon) and stenting (placing a small wire mesh to keep the artery open) have failed or you have experienced restenosis (narrowing of the arteries even after placement of stent). 
  • When a person has suffered a heart attack and is responding to any other treatment

Goals of a Heart Bypass Surgery 

A heart bypass surgery is done to relieve symptoms affecting the quality of life. It aims to fulfil goals such as:

  • Decreasing angina
  • Ability to undertake physical activities
  • Resuming an active lifestyle
  • Improving the heart’s pumping process
  • Improving the chances of survival
  • Lowering the risk of heart attack and stroke
  • Improving the quality of life

However, even after a coronary artery bypass grafting, one has to make strict modifications in lifestyle, habits and diet such as regular medications, healthy diet, physical exercise, no smoking, no alcohol, less stress, healthy weight, and follow-up tests – to ensure that the heart is healthy.

Risk factors of a Heart Bypass Surgery

A heart bypass surgery can have some complications during or after the procedure, such as:

  • Bleeding during or after the surgery
  • Irregular heart rhythm
  • Infection at the incision site
  • Blood clots
  • Memory loss
  • Kidney problem
  • Pneumonia
  • Breathing problem
  • Pancreatitis
  • Graft failure
  • Stroke
  • Heart attack
  • Death

There can be more risks depending on the health of each patient. However, generally, the risks are very low if the health of the patient is good. In cases, where the patient has chronic health conditions or this procedure was performed as an emergency treatment, the chances of risks increase.

Post the surgery, most people tend to remain symptom-free for at least 10-15 years. However, after that, the artery or the graft may need to be revisited through another surgery or angioplasty, as per need. That said, the longevity of a coronary artery bypass grafting is dependent on the patient’s efforts to maintain a healthy lifestyle, eat healthy food, avoid alcohol, avoid smoking, do exercise, maintain a healthy weight, manage stress, control diabetes, and other health problems. Regular heart check-ups also are a great medium to keep a check on the heart’s heart and handle problems before they occur.

Warning Signs and Symptoms of Congestive Heart Failure

Congestive heart failure (CHF) or more commonly known as heart failure, is a chronic progressive condition which affects the pumping power of the heart. It refers to a condition where there is an excessive build-up of fluids around the heart which ultimately reduces the pumping efficiency of the heart.

The heart has four chambers, the upper half comprises of two atria, while the lower comprises of two ventricles, which are responsible for pumping blood to the body’s organs and tissues. On the other hand, atria receive the blood which circulates back from the rest of the body. Congestive heart failure develops when this process is effected causing the ventricles to pump less blood than required by the body. It causes the blood and fluids to accumulate in the lungs, abdomen, liver or lower body.

Congestive heart failure can be life-threatening if proper and timely treatment is not received.

Types of Congestive Heart Failure

The most common type of CHF is the left-sided one, where the left ventricle does not pump enough blood to the body. And as the condition progresses, it leads to an accumulation of fluid in the lungs, making it extremely difficult for a person to breathe.

Two most common types of left-sided heart failure include:

Systolic heart failure: This occurs when the left ventricle fails to function especially contract normally. This problem reduces the force required to push the blood into circulation, thus leading to inefficient heart pumping process.

Diastolic failure: Also known as diastolic dysfunction, occurs when the muscles of the left ventriclebecome too stiff and hence, do not relax as often as they should leading to lack of proper pumping function.

Right-side CHF occurs when the right ventricle has a problem in pumping the blood to the lungs, causing the blood to back up in the blood vessels. This leads to fluid retention in the lower extremities, abdomen and other important organs.

A person can have both left and right side congestive heart failure; however, in most cases, it begins from the left-side and spreads to the right thereafter.

Warning Signs and Symptoms of Congestive Heart Failure

Congestive heart failure can be an ongoing condition (chronic) or can be acute, implying it can develop suddenly. Some of the most common symptoms of congestive heart failure include:

  • Acute shortness of breath, especially while exerting or lying down
  • Fatigue and weakness
  • Swollen legs, ankles and feet
  • Rapid or irregular heartbeat
  • Reduced stamina or the ability to do physical exercise
  • Consistent cough
  • Consistent wheezing along with phlegm
  • Increased urge to urinate at night
  • Swelling in the abdomen
  • Fluid retention
  • Unexplainable and rapid weight gain
  • Lack of appetite
  • Nausea and vomiting
  • Extreme and sudden shortness of breath along with cough with pink or foamy mucus
  • Chest pain (mostly when the CHF is a because of a heart attack)

While these symptoms must be cautiously screened for and in case of doubt, medical help should be immediately sought. However, on the other hand, certain warning signs indicate an urgent need for medical attention, lack of which can cause severe problems including the death of the person.

One must seek emergency treatment if experiencing the following warning signs:

  • Acute chest pain
  • Severe weakness or fainting
  • Rapid or irregular heartbeat along with chest pain, shortness of breath or lack of consciousness
  • Sudden, unexplainable shortness of breath with pink and foamy mucus

Even though these warning signs indicate congestive heart failure, yet merely their presence does not confirm the presence of one. In some cases, the symptoms might indicate a life-threatening lung or heart disease.

Causes of Congestive Heart Failure

Congestive heart failure often occurs when certain heart conditions have damaged or weakened the heart. That said, it can also happen if the heart becomes too stiff to perform well. In a heart failure condition, the chambers of the heart may become too stiff and not efficiently fill between the beats. In other cases of heart failure, the heart muscles can become damaged and weak, causing the ventricles to stretch and dilate to a point that it leads to inefficient pumping of the blood in the body.

Over time, the condition worsens and when the heart can withhold the increased pumping pressure, it tends to cause symptoms and can worsen the patient’s overall health. The pumping function of the heart can be assessed by the ejection function which should ideally be 50 per cent implying that with each beat, the heart pumps out more than half the blood filling the ventricle.

But sometimes even with a normal ejection rate, a person can experience a heart failure since the muscles of the heart can become too stiff due to underlying medical conditions such as high blood pressure.

Some of the other conditions that can weaken or damage the heart muscles and make them stiff include:

  • Coronary artery disease and heart attack
  • High blood pressure or hypertension
  • Damaged heart valves
  • Damaged heart muscles
  • Myocarditis
  • Congenital heart defects
  • Abnormal heart rhythm
  • Other diseases including diabetes, HIV, a build-up of protein or iron, etc.

Among other causes of heart failure, there are viruses which attack the heart muscles, severe infections, allergic reactions, clotting in the lungs, or certain medications, or any other illness which severely impacts the whole body.

However, congestive heart failure can be avoided by taking precautions such as healthy-balanced diet, physical workout, and more. On the other hand, it can also be treated effectively to reduce complications provided it is diagnosed early or medical help is sought well within time.

Understand : Interventional Cardiology

Interventional Cardiology is a sub-specialty of the broader cardiology stream and focuses specifically on the treatment of heart diseases through catheters. A catheter is a long, thin, fine tube mounted with a tiny balloon that is inserted into an artery or vein in the groin, neck or arm and moved to the heart through the blood vessels.

Interventional cardiology uses specialized imaging and diagnostic procedures to assess the flow of blood and pressure in the heart’s arteries and chambers. Moreover, it also involves using technical procedures and medications to cure abnormalities impairing the cardiovascular system. 

Interventional cardiology diagnoses and treats clinical issues such as:

  • Ischemic/coronary heart diseases
  • Heart valve diseases
  • Congenital heart abnormalities
  • Peripheral vascular diseases
  • Resistant hypertension
  • Patent foramen ovale
  • Hypertrophic cardiomyopathy (HCM)

These clinical issues are treated through interventional methods such as:

Angioplasty: This interventional cardiology procedure is undertaken to restore the blood flow to the heart after a heart attack. In this, a catheter mounted with a tiny balloon is inserted into the blocked artery by making an incision in the arm or groin. The catheter is then specifically directed to the area of blockage via special dyes, X-rays, etc. and then the mounted balloon is inflated to remove the blockage from the artery and allow free flow of blood. Post the supply is regulated; the balloon is deflated and removed from the body.

Stenting: Post angioplasty, sometimes the doctors place a stainless-steel mesh known as a stent in the heart to ensure the arteries do not clog again. Some stents are also medically coated to avoid narrowing of the arteries in the future. These stents are placed on top of the balloon on the catheter, such as that upon the opening of the balloon, the stent opens up and reinforces the walls of the artery. 

Rotational Atherectomy: In this procedure, a high-speed instrument – rotary shaver- called burr, is placed at the tip of the catheter and is used to cut through a heavily calcified plaque to reopen a blocked coronary artery. 

Embolic Protection: This interventional cardiology procedure involves eliminating the loose particles of accumulated plaque – that are flowing in the blood – via filters.These loose plaque particles increase the chances of stroke and heart injuries.

Percutaneous Valve Repair: Interventional cardiology can repair damaged valves by using catheters to guide clips and other surgical devices via the blood vessels to repair the valve and restore the flow of blood in the heart.

Balloon Valvuloplasty: In this procedure, a balloon is placed at the top of the catheter which is guided to the narrow or constricted heart valves to stretch it open. When the catheter is at the right place in the heart, the balloon is inflated pushing the walls of the artery to open properly. 

Valve Replacement: This procedure is similar to a balloon valvuloplasty, though the only difference is that there will be implantation of an artificial valve in the replacement of a damaged or a narrowed valve.

Radiofrequency Catheter Ablation: This method uses radio waves to send signals to the heart muscles via a catheter to permanently restrict the abnormal way used by electric signals in the heart. This might involve placing of more than one or more catheter so that energy is directly focussed on the part of the heart causing abnormalities. This cures rapid heartbeats known as tachycardia.

Moreover, in some cases, interventional cardiology might only suggest using medications and adopting certain lifestyle changes to cure the heart problem. Today, interventional cardiology is increasingly being preferred by patients and also being deeply researched by doctors to better the ways of treatment of heart diseases, as well as to widen its horizon to cover more heart problems. 

The main advantages of interventional cardiology are – minimum scars, less pain, lower chances of infections and post-operative complications, and shorter recovery period.

While some of the risks involved in interventional cardiology are:

  • Bruising
  • Bleeding
  • Infection
  • Swelling at incision
  • Heart attack
  • Damage to the artery, veins or area of catheter insertion
  • Irregular rhythm and heartbeat
  • Damage to the kidneys
  • Allergies to dye
  • Allergies to medication
  • Blood clots

The risks are those that apply to all other heart surgeries but its advantages outweigh these risks, though the choice of interventional cardiology treatment will depend on the case of the patient.

Interventional cardiology vs. Surgery

As compared to surgery, interventional cardiology is often the preferred method of treatment. Such as cases of heart attacks that are caused because of artery blockages can be treated via balloon angioplasty to restore normal blood flow. Moreover, in cases where the patient is allergic to general anesthesia, interventional cardiology comes in play because it does not require general anaesthesia during treatment. Risks in interventional cardiology are considerably lower than surgeries and the recovery time is shorter – in many cases the patients can go home the next day.

Further, for patients those are considered riskier for surgeries can be advised for interventional cardiology treatment. Broadly, interventional cardiology is a lower-risk alternative as compared to surgical procedures for some heart problems. 

CABG – Coronary Artery Bypass Grafting

Coronary artery bypass grafting (CABG) is a surgical procedure to improve poor blood flow to the heart caused by narrowing or blocking of arteries due to the build-up of plaque. These arteries called coronary arteries are blood vessels responsible for supplying blood, oxygen, and nutrients to the heart tissue. When these arteries are blocked or narrowed due to the accumulation of plaque – fatty material within the walls of the arteries – the heart is restricted or has a limited supply of oxygen-rich blood, causing severe symptoms including a heart attack in severe cases.

This plaque is formed in the arteries when the inner walls of the arteries are damaged or injured due to several factors such as an unhealthy diet, smoking, high blood pressure, high cholesterol, diabetes, and a sedentary lifestyle. This plaque – a build-up of fat, cholesterol, calcium, and other substances – tends to stick to the inner walls of the arteries, restricting the blood flow and thereby causing a system malfunction. 

Factors that increase the chances of a blockage or narrowing in the arteries include:

  • Increasing age
  • Sex – Men are more prone than women
  • Family history of heart disease or problems
  • Smoking
  • High blood pressure
  • High cholesterol level
  • Diabetes
  • Overweight or obesity
  • Physical inactivity
  • High stress
  • Unhealthy diet

A coronary artery bypass grafting redirects the blood flow to the narrowed or blocked artery by using healthy blood vessels from the leg veins, arm or chest and connecting them with the blood vessels that are beyond the blocked or narrowed artery – causing a bypass for the compromised artery to relive the blood flow as a new passage is able to supply oxygen-rich blood to the blocked area. Depending on the severity of the case, one or more blood vessels may be used to bypass the affected artery. In one case, four major blocked arteries can be bypassed at once. 

Coronary artery bypass grafting is a very successful surgical procedure and one of the prime methods used to correct blockages, leakages or narrowing of the coronary arteries. It is an open surgery also popularly known as bypass surgery, coronary artery bypass surgery or heart bypass surgery. 

Types of Coronary artery bypass grafting

Traditional Coronary artery bypass grafting: This is the most common method used to treat blockages of the main artery by opening the chest bone to access the heart and stop it to connect it to a heart-lung bypass machine. This machine keeps supplying blood and oxygen to the tissue to keep the heart alive, meanwhile allowing the surgeon to relieve the blockage. Post the surgery, blood flow is restored and the heart starts beating properly.

Off-pump coronary artery bypass grafting: This is similar to a traditional coronary artery surgery, the heart is accessed via an incision in the chest bone but it is not stopped and neither is placed on a bypass machine, instead the blockage is treated on the beating heart.

Minimally-invasive coronary artery bypass grafting: A fairly new but minimally invasive procedure that uses several small incisions on the left side of the chest, between the ribs to access the heart instead of a large cut in the chest bone. This procedure primarily restores blood flow to the blood vessels in front of the heart. However, it is not effective in severe cases or cases that have more than one or two blocked or narrowed arteries.

Why is it done?

A coronary artery bypass grafting may be done if you have a blocked artery causing symptoms such as:

  • Severe chest pain
  • Shortness of breath
  • Fatigue
  • Abnormal heart rhythm
  • Swollen hands and feet
  • Severe indigestion
  • Palpitations

However, in many cases there might not be any symptoms due to the initial stage; however, eventually with the increased build-up of plaque and blockage, symptoms will tend to show. In some cases, the symptoms are very last minute and often result in a heart attack and if the blood flow is not restored to the affected area within a stipulated time, the heart tissue will die, causing death. 

A doctor might also recommend a coronary artery bypass grafting in the below cases:

  • When there is more than one compromised artery causing the left chamber of the heart to dysfunction
  • When the main artery in the left chamber of the heart is the affected one
  • When there is acute chest pain even while light physical work because of several artery blockages
  • When procedures such as angioplasty (removal of blockage through inflated balloon) and stenting (placing a small wire mesh to keep the artery open) have failed or you have experienced restenosis (narrowing of the arteries even after placement of stent). 
  • When a person has suffered a heart attack and is responding to any other treatment

Goals of the surgery

A coronary artery bypass surgery is done to relieve symptoms affecting the quality of life. It aims to fulfil goals such as:

  • Decreasing angina
  • Ability to undertake physical activities
  • Resuming an active lifestyle
  • Improving the heart’s pumping process
  • Improving the chances of survival
  • Lowering the risk of heart attack and stroke
  • Improving the quality of life

However, even after a coronary artery bypass grafting, one has to make strict modifications in lifestyle, habits, and diet such as regular medications, healthy diet, physical exercise, no smoking, no alcohol, less stress, healthy weight, and follow-up tests – to ensure that the heart is healthy.

Risk factors

A coronary artery bypass surgery can have some complications during or after the procedure, such as:

  • Bleeding during or after the surgery
  • Irregular heart rhythm
  • Infection at the incision site
  • Blood clots
  • Memory loss
  • Kidney problem
  • Pneumonia
  • Breathing problem
  • Pancreatitis
  • Graft failure
  • Stroke
  • Heart attack
  • Death

There can be more risks depending on the health of each patient. However, generally, the risks are very low if the health of the patient is good. In cases, where the patient has chronic health conditions, or this procedure was performed as an emergency treatment, the chances of risks increase.

Post the surgery, most people tend to remain symptom-free for at least 10-15 years. However, after that, the artery or the graft may need to be revisited through another surgery or angioplasty, as per need. That said, the longevity of a coronary artery bypass grafting is dependent on the patient’s efforts to maintain a healthy lifestyle, eat healthy food, avoid alcohol, avoid smoking, do exercise, maintain a healthy weight, manage stress, control diabetes, and other health problems. Regular heart check-ups also are a great medium to keep a check on the heart’s heart and handle problems before they occur.

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