Nikaidoh procedure ppt. Also, the pulmonary outflow is less likely to be .

Nikaidoh procedure ppt. Presented at the Fourth World Congress of Pediatric Cardiology and Cardiac Surgery, 2005. It can act as an alternative approach for TGA/VSD/PS if both ventricles are well developed. In this issue of The Annals of Thoracic Surgery, the group provides a single-institution, retrospective analysis of patient outcomes after the Rastelli and Nikaidoh procedures based on prospectively determined pathoanatomic features. Results: The Nikaidoh procedure was the most time-consuming in terms of mean car-diopulmonary bypass and aortic crossclamp times. Oct 18, 2023 · The Nikaidoh procedure was initially developed for standard forms of d-TGA with a conoventricular VSD and LVOTO. Because of disappointment with the Rastelli operation, the senior author (HN) developed the aortic translocation oper-ation as an alternative procedure. Although the Rastelli operation has been standard surgical management of this lesion, aortic root translocation with right ventricular outflow tract (RVOT) reconstruction (Nikaidoh) and the pulmonary artery translocation (Lecompte) or REV Aug 28, 2025 · Conclusions A double-switch operation using a modification of the Nikaidoh procedure is a good option for ccTGA with LVOTS when the VSD anatomy is unfavorable for intraventricular rerouting. The Nikaidoh procedure, or aortic translocation, is an alternative used when anatomy is unsuitable for Rastelli or Lecompte, involving translocating the aortic root posteriorly to relieve LVOTO. The author also describes an 'ideal' candidate and technical aspects of performing the standard Jan 1, 2009 · MMCTS brings online training for cardio-thoracic surgeons to an entirely new level with step-by-step video demonstrations of surgical procedures, supported by succinct text and clear graphics. The document discusses the anatomy of D-TGA, associated defects like VSD that can occur, natural history, clinical features The Nikaidoh procedure was initially developed for stan-dard forms of d-TGA with a conoventricular VSD and LVOTO. The Rastelli procedure is the standard surgical treatment of d-transposition of great arteries (d-TGA), ventricular septal defect (VSD), and pulmonary stenosis. Results of the first two patients undergoing the aortic translocation operation were reported in 1984. 2006; 54:558-560 Crossref Scopus (9) Jun 13, 2025 · Explore the Nikaidoh procedure, a surgical technique used to treat complex congenital heart defects, and its significance in cardiovascular surgery. Then, in 1984, Nikaidoh [2] described and popularized the concept of aortic The Nikaidoh procedure originally consisted of translocating the aortic root in a direct posterior fashion, involving the resectioning of the infundibular septum while leaving the coronary arteries in place. Jun 1, 2022 · What is known on this subject? The Nikaidoh procedure is a complicated surgery that has only been performed for 100 patients to date. The arterial switch operation is usually not feasible because of the resulting valvar and subvalvar aortic stenosis. Sep 6, 2018 · In 1984, Nikaidoh described the concept of aortic translocation for the management of transposition of the great arteries (TGA) with a ventricular septal defect (VSD) and pulmonary stenosis (PS). We reviewed our experience with aortic root translocation and the impact of the type of right ventricular outflow tract reconstruction. CPT 33782 refers to the aortic root translocation procedure, specifically designed for patients with a ventricular septal defect and pulmonary stenosis. Methods: Nineteen patients underwent a Nikaidoh procedure at a median age of 3. We investigated the intermediate-term outcomes of Fontan versus biventricular procedures in these patients. The aortic translocation is also called the Nikaidoh procedure, named after Dr. Bar graphs are used to illustrate utilization of each procedure type by individual center and by year. This document provides information on dextro-transposition of the great arteries (D-TGA), including that it accounts for 5-7% of congenital heart defects and has a 3:1 male to female ratio. Patients with TGA/VSD/PS or double-outlet right ventricle (DORV) with malposed great vessels and PS who also present with a restrictive or inlet-type VSD, a hypoplastic right ventricle, or a Jul 11, 2023 · The patient is a two-and-a-half-year-old child with d-TGA/VSD/PS who underwent aortic translocation. Sep 11, 2018 · Currently the posterior translocation of the aorta, the Nikaidoh procedure, is utilized in: complete transposition of the great arteries (d-TGA) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) [1,2,3] (video 1), corrected TGA (ccTGA) with VSD and complex LVOTO [4,5], and double outlet right ventricle (DORV) - TGA type with complete atrioventricular To reduce postoperative coronary artery- and LVOT-related complications, we performed a modified Nikaidoh procedure involving the Lecompte maneuver, coronary artery transfer, and aortic root translocation; this procedure allowed for a shortened LVOT, orthotopic positioning of the RVOT, and natural intracardiac geometry [7]. 3K subscribers Subscribe May 1, 2018 · Nikaidoh Procedure May 1, 2018 Presented by: Victor Hraska, Children's Hospital of Wisconsin Source: Annual Meeting 2018, San Diego, CA Congenital Heart Disease Aug 22, 2018 · D-transposition of the great arteries and l-transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction are complex biventricular congenital heart diseases for which decision-making regarding surgical strategy remains challenging. A new surgical repair for transposition of the great arteries associated with a ventricular septal defect and pulmonary stenosis. To avoid recurrent LVOTO, we routinely enlarge the VSD and resect Dr. Atrial switch procedures (Mustard or Senning operation) with relief of the left ventricular outflow The Nikaidoh procedure presents several unique challenges, including the complexity of the anatomical structures involved and the need for precise surgical technique. The patient’s anatomy was typical of d-transposition with VSD and PS. Complications of the atrial switch procedure include residual shunts, caval/pulmonary Nikaidoh Procedure Repair. This procedure allows for a more anatomically aligned left ventricular outflow tract (LVOT), and the intermediate to midterm results of the Nikaidoh procedure appear superior to the Rastelli procedure in the late development of LVOTO, at the cost of higher technical complexity of the initial operation and longer operative times. The procedure aims to repair the This retrospective study using The Society of Thoracic Surgeons Congenital Heart Surgery Database evaluates surgical procedure utilization and outcomes of patients undergoing repair of TGA-VSD-LVOTO and DORV-TGA with a Nikaidoh, Rastelli, or REV procedure. This study aims to compare the long-term results of the five main procedures: the atrial switch, arterial switch, Nikaidoh, Rastelli, and REV operations, and presented the long-term features of each procedure. [16] The modification involved preserving the native PV to minimize postoperative pulmonary insufficiency. Aortic translocation and biventricular outflow tract reconstruction. The Nikaidoh procedure is a surgery that can be used to correct congenital heart defects, such as double outlet right ventricle (DORV) or transposition of the great arteries (TGA) with narrowing of the pulmonary valve (stenosis). Aug 3, 2021 · UPMC uses the Nikaidoh procedure for complex TGA and has worked to establish the safety, efficacy, and durability of this surgery. There are little data on the outcomes of this procedure, with no long-term follow-up available. When compared to other surgical options, the Nikaidoh procedure results in a ‘more normal’ anatomic result, with better alignment of the right and left ventricular outflow tracts. Aug 25, 2021 · To address various problems with conventional surgical procedures for transposition of the great arteries with left ventricular outflow obstruction, the aortic translocation procedure has been reconsidered as an alternative surgical procedure. Aug 22, 2025 · CPT® Code 33783 in section: Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, Nikaidoh procedure) This document discusses the Nikaidoh procedure, which involves translocating the aortic root from the right ventricle to the left ventricle. It provides background on the development of the procedure and outlines its expanded applications over time to treat more complex congenital heart defects. Cook Children's cardiothoracic surgeons Drs. Aug 4, 2025 · The Nikaidoh procedure is a surgical intervention used to correct congenital heart defects such as double outlet right ventricle (DORV) or transposition of the great arteries (TGA), particularly when pulmonary muscle is narrowing. This study was designed to compare these procedures in terms of hemodynamics of the reconstructed biventricular outflow tract, early Nikaidoh procedure is a surgery that can be used to correct congenital heart defects, such as double outlet right ventricle (DORV) or transposition of the great arteries (TGA) with narrowing of These procedures, particularly the Nikaidoh procedure, involve complex surgical techniques to reestablish proper anatomical relationships and ensure adequate blood circulation. Surgical management of d-transposition of the great arteries associated with ventricular septal defect (VSD) and left ventricular outflow tract obstruction remains a challenge. Aortic translocation/Nikaidoh procedure The aortic translocation is also called the Nikaidoh procedure, named after Cook Children's surgeon, Dr. Jun 20, 2011 · 6/20/2011 Surgery: Transposition (d-TGA), SubPS, Nikaidoh Procedure From Springer Images Posted by Bala at May 25, 2016 · Twenty-one patients (66%) underwent the double-switch procedure, 5 patients (16%) underwent Senning-Rastelli procedure, and 6 patients (19%) underwent Senning-Bex/Nikaidoh procedure. In 1980, Bex and colleagues [1] reported a new surgical technique for the management of transposition of the great arteries that involved moving the aortic root with the attached coronary arteries to the pulmonary position as a way to provide a true “anatomic correction” for transposition of the great arteries. 1. 28 (Note the Y-axis ranges from 50% to 100% freedom from death. Therefore, I find it important that the surgeon be familiar with these procedures to ensure an expeditious operation. This is a surgery that can be used to correct congenital heart defects such as a double outlet right ventricle or the transposition of the great arteries with stenosis (narrowing) of the pulmonary valve. May 3, 2025 · The Nikaidoh procedure is a viable option for TGA type DORV, pulmonary valve stenosis, and superior-inferior ventricular morphology. pdf), Text File (. A posterior aortic root translocation (known as Nikaidoh procedure) is performed when the native PV is unsuitable for use as the neo-AV (see last page) and when the aorta is too remote from the VSD for a Rastelli closure of the VSD. Nikaidoh made this a true educational experience across our unit—he presented a lecture on the potential pitfalls of the procedure and looked over our shoulders during the surgery, coaching us on the operation he created,” says Vricella. to address potential limitations of a RV-PA conduit or a transannular patch. Oct 15, 2019 · However, the experience is still limited and the Nikaidoh procedure has some limitations. Jan 1, 2008 · The optimal surgical management of patients with transposition of the great arteries with a ventricular septal defect and pulmonary stenosis remains challenging. With EBR, both the native aortic and native However, more aggressive procedures, including aortic root translocation (eg, the original Nikaidoh procedure) and double root trans-location (DRT), have recently become important treat-ments of choice [1, 2]. Abnormal coronary anatomy with posterior looping around the great vessels and papillary muscle crossing the VSD are relative contraindications. Compared with REV, it can achieve a shorter and more straight left ventricular outflow tract. The Senning procedure was added for those with atrioventricular discordance. Surgical repair depends on the location of the ventricular septal defect The optimal surgical treatment of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis is controversial. * (A-C): SRT- Nikaidoh; ** (D-F): DRT: en bloc rotation- Yamagishi/Mair; *** (G-I): DRT: individual root harvest- Hu. We developed the “hemi-Nikaidoh” procedure as an Nov 14, 2016 · Background The surgical treatment for complex forms of d -transposition of the great arteries associated with ventricular septal defect and left ventricular outflow tract obstruction remains controversial. Nikaidoh Procedure Jun 5, 2007 · Three techniques have been developed as the surgical management for patients with anomalies of ventriculoarterial connection, ventricular septal defect, and pulmonary outflow tract obstruction (stenosis): the Rastelli, Lecompte, (REV), and Nikaidoh procedures. Nikaidoh became Children's Health's first full-time pediatric heart surgeon in 1978 when the field was still relatively new. Because of the complexity of her heart condition, the exact procedure to repair her heart is extremely rare. To begin the procedure, the patient was positioned supine on the operating room table. It is published as a free service by the European Association for Cardio-Thoracic Surgery. 3 years). The procedure has shown acceptable hospital mortality rates and May 11, 2022 · The long-term survival was satisfactory regardless of the surgical technique except Nikaidoh group. Patients and methods Patient population and study design ion a l'etage ventriculaire” or aortic root translocation (Bex-Nikaidoh procedure). 3 years (0. Rastelli, REV (Réparation à l'Etage Ventriculaire), Nikaidoh, and “en bloc rotation” techniques are all described with their respective history, advantages, and drawbacks. A scatter plot illustrates the incidence of total Nikaidoh or Rastelli operations by annualized center volume of index cardiac procedures. Hazekamp MG, et al. Morell, MD The Annals of Thoracic Surgery Volume 104 Issue 5 Pages 1446-1449 (November 2017) En bloc aortic root translocation with the coronary arteries attached. DORV can be acyanotic or cyanotic depending on associated lesions. Modified Nikaidoh procedure for transposition of great arteries Ventricular septal defect and left ventricular outflow tract obstruction Thorac Cardiovasc Surg. . Prodip Kumar Biswas discusses the Nikaidoh Operation for complex congenital heart defects, including TGA VSD PS, DORV Subp Procedure Powerpoint Templates and Google Slides Themes Craft seamless procedures with our fully customizable presentation templates, designed to simplify and enhance your workflow. Half of D-TGA cases have no other associated defects besides a PFO or PDA. Nikaidoh’s major technical principle with the concepts of the Ross-Konno and the arterial switch procedure (14). Aortic translocation procedures, such as the Nikaidoh procedure and the half-turned truncal switch operation, are effective surgical options for TGA with LVOTS1,2; however, in ccTGA they carry a high risk of A-V block because of its specific characteristics in A-V conduction. The native aortic valve was translocated from the right to the left The aortic translocation (Nikaidoh) procedure: Midterm results superior to the Rastelli procedure. The Nikaidoh procedure is a complex surgical intervention that combines technical elements found in the Ross-Konno and arterial switch procedures. The key features include aortomitral discontinuity and two ventricular outflow tracts. Despite offering the advantages of a more anatomic repair, the Nikaidoh procedure involves a higher degree of technical complexity owing to manipulation of the aortic root. May 17, 2016 · Conclusions: Modified Nikaidoh procedure with double-root-translocation is a complex procedure, but reproducible. The Bex-Nikaidoh procedure allows a more normal, anatomically aligned left ventricular outflow tract. Both coronaries were favorable in that they were off of the epicardium. Methods: All patients who underwent aortic root translocation In this detailed presentation, Dr. We have used an alternative approach that combines Dr. It also discusses the two main corrective surgeries - the arterial switch operation and atrial switch (Mustard/Senning) repairs. Of 21 patients who underwent the double-switch, 14 had a VSD, and 7 had an intact ventricular septum. Complete mobilization of A single-valved bovine jugular vein patch was used to repair the stenotic pulmonary artery in both Nikaidoh and REV procedures. Esta cirugía implica la “translocación” de la aorta Jun 23, 2023 · The Nikaidoh procedure was initially developed for standard forms of d-TGA with a conoventricular VSD and LVOTO. org/article/nikaid Different procedures can be used to repair transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction. The Nikaidoh Operation: An Aortic Translocation Repair CTSNetVideo 76. It results in an anatomical normal heart, even better than with an ASO, because also the cones are switched instead of only the arteries as with an ASO. Late morbidity is significant due to recurrent left ventricular outflow obstruction (LVOTO), early conduit obstruction, and arrhythmias, with troublesome late mortality. He and other heart surgeons took on the task of developing procedures to repair congenital heart defects, which are structural heart problems that happen when the heart doesn't form properly in the womb. Superior preservation of the left ventricular outlet after the aortic translocation (Nikaidoh) procedure. Studies that have assessed the Rastelli and Nikaidoh operations for transposition of the great arteries (TGA) with obstructed left ventricular outflow tract obstruction (LVOTO) have not fully evaluated the anatomic drivers that may contribute to surgical selection. However, other techniques such as aortic root translocation (Bex-Nikaidoh procedure), pulmonary root translocation, and double root translocation are equivalent or in fact provide better results than the traditional techniques. Overall, the hemi-Nikaidoh procedure is an effective anatomic repair of d-TGA/VSD/PS in select patients with a diminutive pulmonary root and underdeveloped conus. Dec 15, 2016 · Modified Nikaidoh procedure in a patient with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction with unusual coronary anatomy Apr 29, 2024 · The Bex-Nikaidoh procedure is a surgical option for transposition of the great arteries (TGA) or double outlet right ventricle (DORV) with ventricular septal defects (VSD) and pulmonary stenosis (PS). Common Language Description The Nikaidoh procedure, designated by CPT® Code 33782, is a specialized surgical intervention aimed at correcting a complex cardiac anomaly characterized by the presence of transposition of the great arteries (TGA), a ventricular septal defect (VSD), and pulmonary stenosis (PS). A Bex-Nikaidoh procedure is feasible for complex TGA with VSD and left ventricular outflow tract obstruction with the relative contraindication of posterior coronary artery looping related to risk of coronary artery injury. We would like to show you a description here but the site won’t allow us. We report our experience with a modi fied Nikaidoh procedure with DRT using a valve-spared pulmonary root. Double outlet right ventricle (DORV) is a congenital heart defect where both the aorta and pulmonary artery arise completely or predominantly from the right ventricle. In 1984, Nikaidoh [4] first utilized a new corrective method for TGA with VSD and pulmonary stenosis that was based on aortic root translocation. The Nikaidoh operation is a surgical technique used for complex cases of transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS), aiming to create a more normal anatomy. Reports on the midterm follow-up (>10 years) on the Lecompte procedure have been limited, reported as 79% at 15 years. The Nikaidoh procedure has been free of late mortality in this and Morell and colleagues’ series. The Nikaidoh procedure was initially developed for standard forms of d-TGA with a conoventricular VSD and LVOTO. ” The Nikaidoh procedure is a wonderful example of the spirit and history of congenital heart surgery. Aortic root translocation is a promising surgical option for repair of transposition of the great arteries, ventricular septal defect, and pulmonary stenosis. The Nikaidoh procedure is a complex surgical interven-tion that combines technical elements found in the Ross-Konno and arterial switch procedures. This video may be inappropriate for some users. Unlike the traditional procedures such as the Rastelli and Réparation à l'Etage Ventriculaire (REV) procedure, which often necessitate reoperation due to right or left ventricular outflow tract Utilization and outcomes of the Nikaidoh, Rastelli, and REV procedures: an analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Among repairs for ventriculoarterial discordance, ventricular septal defect, and pulmonary stenosis, aortic root translocation (Nikaidoh operation) offers the most anatomic result. The overall experience with the double switch and atrial switch/Rastelli operation has been satisfactory with preservation of LV function and decrease in left atrioventricular valve regurgitation. The Nikaidoh procedure is an innovative surgical technique used for the repair of d-transposition of the great vessels and pulmonary stenosis. The ‘Réparation a l’etage ventriculaire’, also known as the REV procedure, offers reconstruction of the RVOT without the use of extracardiac prostheses. The surgical option for transposition of the great arteries with left ventricular outflow tract obstruction should be selected based on the features of the respective procedures. Hisashi Nikaidoh. Several surgical approaches have been proposed to correct the transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO). Moreover, preoperative 3D reconstruction can accurately predict the outcomes of this complex procedure. A median sternotomy was performed, along with the usual Jan 31, 2025 · Figure 1 Aortic root translocation and double root translocation. The RVOT is reconstructed with the largest possible quantity of autologous tissue to ensure some extent of growth potential. txt) or view presentation slides online. Nikaidoh. We present our procedural selection process for optimizing outcomes of complex TGA in the modern era. May 4, 2018 · “Dr. We developed another innovative translocation technique, the half-turned truncal switch operation, to make use of various anatomical characteristics Yeh T, Ramaciotti C, Leonard SR, Nikaidoh H. The Nikaidoh procedure is a type of arterial switch procedure in which the aorta is mobilized and translocated posteriorly along with the coronary arteries to the pulmonary annulus, a pathway from the RV to the pulmonary arteries is created, and the VSD is closed (24). (10) Another approach in complex forms of TGA is the Nikaidoh procedure. This article explores the relevant CPT codes associated with these repair procedures, detailing their specific uses and documentation requirements. J Thorac Cardiovasc Surg 2007; 133:461-9. 1 The procedure was proposed as a tech-nique to avoid obstruction of the right and left ventricular outflow tracts. Sep 6, 2018 · Nikaidoh H. 2013 Nikaidoh Talk - Free download as PDF File (. It describes palliative procedures like atrial septostomy and shunts that can be used. This procedure involves "transferring" the great arteries to the left ventricle and then reconstructing the pathway from the right ventricle to the pulmonary artery The patient is doing well at 3-month follow-up. But Nikaidoh has put the procedure in practice in 1984. This could potentially allow growth of the pulmonary root and therefore decrease the need for reoperation. 9-9. The presented the modification of the Nikaidoh procedure is useful for avoiding A-V block. What this techinical reports adds? Performing the Nikaidoh procedure on a beating heart provides advantages. ctsnet. Therefore, I nd it fi important that the surgeon be familiar with these pro-cedures to ensure an expeditious operation. The principle for harvest of the neo-aortic root is that of enucleation (A, E, G) performed analogous to a Ross procedure, whether a SRT or DRT is then performed. Nikaidoh Procedure: How I Teach It Victor O. The provider must navigate the intricate relationships between the aorta, pulmonary artery, and coronary arteries while ensuring that blood flow is restored effectively. Posterior movement of the aortic root, with or without rotation, is essential for the Nikaidoh procedure. With a diminutive pulmonary annulus or hypoplastic left ventricular outflow tract, the distance gained posteriorly with aortic translocation is negligible. Learn more: https://www. Surgery for transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction: European Congenital Heart Surgeons Association multicentre study. The Bex-Nikaidoh procedure was modified by Hu et al. Leaving one-third of the root in place may avoid bleeding complications of a posterior suture line. Also, the pulmonary outflow is less likely to be This document discusses the management of complete transposition of the great arteries (TGA). Tam and Nikaidoh performed a complex atrial switch operation, along with an aortic translocation. However, the operation is technically demanding, and coronary translocation remains one of the major challenges for successful root translocation. This procedure is particularly significant in pediatric cardiology, as it addresses Mar 1, 2018 · Different procedures can be used to repair transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction. Download the Nikaidoh Procedure reference (PDF). “the theoretical advantages of the Bex—Nikaidoh procedure or posterior translocation of the aorta are obvious: no volume reduction of the RV, an ‘anatomical’ connection of LV to aorta, orthotopic placement of the RV-to-PA conduit, and no right ventriculotomy. In this study, we describe the classical surgical options – namely, the Rastelli procedure and the “ réparation à l’étage ventriculaire ” – and present our experience with the The Nikaidoh procedure is a useful technique for patients with complex transposition of the great arteries. Continuous variables are represented are represented as median with interquartile range (IQR). A Bex-Nikaidoh procedure is feasible for complex TGA with VSD and left ventricular outflow tract obstruction with the rela-tive contraindication of posterior coronary artery looping related to risk of coronary artery injury. ) REV , Réparation á l’étage ventriculaire. The surgery involves the El procedimiento de Nikaidoh es una cirugía que se puede utilizar para corregir defectos car-díacos congénitos, como el doble salida ventricular derecha (double outlet right ventricle, DORV) o la transposición de las grandes arterias (transposition of the great arteries, TGA) con estrechamiento de la válvula pulmonar (estenosis). This surgical intervention, known as the Nikaidoh procedure, involves repositioning the aortic root to the pulmonary position, excising the pulmonary valve, and reconstructing the outflow tracts of the heart. Nikaidoh procedure Normal Heart Norwood procedure One and a half ventricle repair Patent ductus arteriosus Primum atrial septal defect Pulmonary artery band Pulmonary artery sling and tracheal stenosis Pulmonary atresia with intact ventricular septum Pulmonary atresia with ventricular septal defect Pulmonary stenosis Rastelli procedure Ross Nikaidoh procedure: It consists in mobilizing the aortic root and coronary arteries posteriorly, doing a LeCompte maneuver, resecting the main pulmonary artery and replacing it with a right ventricle to pulmonary artery conduit and closing the VSD with a patch. Objective: Midterm follow-up is analyzed after the aortic translocation (Nikaidoh) procedure, an alternative to the Rastelli procedure for ventriculoarterial discordance, ventricular septal defect, and pulmonary stenosis. 5qvn i5 fnza pm p7k2p ttkf ijtz8ikx0 7tcro jhdd jo94g

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