652:
in MS, the typical auscultatory findings, including the diastolic rumbling murmur, may not be detectable (silent MS), but they may reappear as compensation is restored. The Graham Steell murmur of pulmonary regurgitation, a high-pitched, diastolic, decrescendo blowing murmur along the left sternal border, results from dilation of the pulmonary valve ring and occurs in patients with mitral valve disease and severe pulmonary hypertension. This murmur may be indistinguishable from the more common murmur produced by aortic regurgitation (AR), although it may increase in intensity with inspiration and is accompanied by a loud and often palpable P2.
485:
303:
43:
412:. As the gradient across the mitral valve increases, the amount of time necessary to fill the left ventricle with blood increases. Eventually, the left ventricle requires the atrial kick to fill with blood. As the heart rate increases, the amount of time that the ventricle is in diastole and can fill up with blood (called the diastolic filling period) decreases. When the heart rate goes above a certain point, the diastolic filling period is insufficient to fill the ventricle with blood and pressure builds up in the left atrium, leading to pulmonary congestion.
369:
877:
206:
400:. A normal mitral valve will not impede the flow of blood from the left atrium to the left ventricle during (ventricular) diastole, and the pressures in the left atrium and the left ventricle during ventricular diastole will be equal. The result is that the left ventricle gets filled with blood during early ventricular diastole, with only a small portion of extra blood contributed by contraction of the left atrium (the "atrial kick") during late ventricular diastole.
747:, which is a marker for the severity of mitral stenosis. This method of evaluating mitral stenosis tends to overestimate the degree of mitral stenosis, however, because of the time lag in the pressure tracings seen on the right-heart catheterization and the slow Y descent seen on the wedge tracings. If a trans-septal puncture is made during right heart catheterization, however, the pressure gradient can accurately quantify the severity of mitral stenosis.
1487:
743:) gives the physician the mean pulmonary capillary wedge pressure, which is a reflection of the left atrial pressure. The left heart catheterization, on the other hand, gives the pressure in the left ventricle. By simultaneously taking these pressures, it is possible to determine the gradient between the left atrium and left ventricle during ventricular
542:), when the pressure in the ventricle precipitously drops. In individuals with mitral stenosis, the pressure in the left atrium correlates with the severity of the mitral stenosis. As the severity of the mitral stenosis increases, the pressure in the left atrium increases, and the mitral valve opens earlier in ventricular diastole.
933:
Although the immediate results of PBMV are often quite gratifying, the procedure does not provide permanent relief from mitral stenosis. Regular follow-up is mandatory, to detect restenosis. Long-term follow-up data from patients undergoing PBMV indicates that up to 70–75% individuals can be free of
925:
With careful patient pre-selection, percutaneous balloon mitral valvuloplasty (PBMV) is associated with good success rates and a low rate of complications. By far the most serious adverse event is the occurrence of acute severe mitral regurgitation. Severe mitral regurgitation usually results from a
651:
With severe pulmonary hypertension, a pansystolic murmur produced by functional tricuspid regurgitation may be audible along the left sternal border. This murmur is usually louder during inspiration and diminishes during forced expiration (Carvallo's sign). When the cardiac output is markedly reduced
454:
In individuals with severe mitral stenosis, the left ventricular filling is dependent on the atrial kick. The loss of the atrial kick due to atrial fibrillation (i.e., blood cannot flow into the left ventricle thus accumulating in the left atrium ) can cause a precipitous decrease in cardiac output
917:
portion (lying in the left ventricle) is inflated and pulled against the valve cusps. Second, the proximal portion is dilated, in order to fix the centre segment at the valve orifice. Finally, the central section is inflated, this should take no longer than 30 seconds, since full inflation obstructs
458:
Patients with mitral stenosis prompts a series of hemodynamic changes that frequently cause deterioration of the patient's clinical status. A reduction in cardiac output, associated with acceleration of heart rate and shortening of the diastolic time, frequently leads to congestive heart failure. In
415:
When the mitral valve area goes less than 1 cm, there will be an increase in the left atrial pressures (required to push blood through the stenotic valve). Since the normal left ventricular diastolic pressures is about 5 mmHg, a pressure gradient across the mitral valve of 20 mmHg due to severe
929:
Other serious complications with PBMV usually relate to the technique of trans-septal puncture (TSP). The ideal site for TSP is the region of the fossa ovalis in the inter-atrial septum. Occasionally, however, the sharp needle used for TSP may inadvertently traumatize other cardiac structures,
189:. Normally, the mitral valve is about 5 cm during diastole. Any decrease in area below 2 cm causes mitral stenosis. Early diagnosis of mitral stenosis in pregnancy is very important as the heart cannot tolerate increased cardiac output demand as in the case of exercise and pregnancy.
504:) because of increased force in closing the mitral valve. The first heart sound is made by the mitral and tricuspid heart valves closing. These are normally synchronous, and the sounds are termed M1 and T1, respectively. M1 becomes louder in mitral stenosis. It may be the most prominent sign.
821:
criteria: leaflet mobility, leaflet thickening, subvalvular thickening, and calcification. Individuals with a score of ≥ 8 tended to have suboptimal results. Superb results with valvotomy are seen in individuals with a crisp opening snap, score < 8, and no calcium in the commissures.
642:
Heart rate is about 100-150/min. Irregularly irregular pulse with a pulse deficit>10. Varying first heart sound intensity. Opening snap is not heard sometimes. Absent a waves in the neck veins. Presystolic accentuation of diastolic murmur disappears. Embolic manifestations may appear.
287:(the most common cause) is an asymptomatic latent phase following the initial episode of rheumatic fever. This latent period lasts an average of 16.3 ± 5.2 years. Once symptoms of mitral stenosis begin to develop, progression to severe disability takes 9.2 ± 4.3 years.
372:
Intracardiac pressure measurements in an individual with severe mitral stenosis. Pressure tracings in the left atrium (LA) and the left ventricle (LV) in an individual with severe mitral stenosis. Blue areas represent the diastolic pressure gradient due to the stenotic
470:
II symptoms to the development of atrial fibrillation to the development of NYHA functional class III or IV symptoms. Once an individual develops NYHA class III or IV symptoms, the progression of the disease accelerates and the patient's condition deteriorates.
1453:
Fawzy, ME; Shoukri, M; Al
Buraiki, J; Hassan, W; El Widaal, H; Kharabsheh, S; Al Sanei, A; Canver, C (2007). "Seventeen years' clinical and echocardiographic follow up of mitral balloon valvuloplasty in 520 patients, and predictors of long-term outcome".
3038:
3015:
403:
When the mitral valve area goes below 2 cm, the valve causes an impediment to the flow of blood into the left ventricle, creating a pressure gradient across the mitral valve. This gradient may be increased by increases in the
1270:
534:), which correlates to the forceful opening of the mitral valve. The mitral valve opens when the pressure in the left atrium is greater than the pressure in the left ventricle. This happens in ventricular
360:, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, whipple disease, fabry disease, and rheumatoid arthritis. hurler' disease, hunter's disease, amyloidosis.
549:
with presystolic accentuation will be heard after the opening snap. The murmur is best heard at the apical region and is not radiated. Since it is a low-pitch sound, it is heard best with the
817:
Another option is balloon dilatation. To determine which patients would benefit from percutaneous balloon mitral valvuloplasty, a scoring system has been developed. Scoring is based on 4
926:
tear in one of the valve leaflets or the subvalvular apparatus. It can lead to pulmonary edema and hemodynamic compromise, necessitating urgent surgical mitral valve replacement.
2202:
1266:
811:
467:
1256:
VOC=VITIUM ORGANICUM CORDIS, a compendium of the
Department of Cardiology at Uppsala Academic Hospital. By Per Kvidal September 1999, with revision by Erik Björklund May 2008
2628:
2981:
889:
Mitral valvuloplasty is a minimally invasive therapeutic procedure to correct an uncomplicated mitral stenosis by dilating the valve using a balloon. Under
2679:
1843:
3142:
416:
mitral stenosis will cause a left atrial pressure of about 25 mmHg. This left atrial pressure is transmitted to the pulmonary vasculature and causes
2684:
1533:
1365:"Percutaneous balloon dilatation of the mitral valve: An analysis of echocardiographic variables related to outcome and the mechanism of dilatation"
1082:
2260:
913:
passed into the left atrium using a "trans-septal technique." The balloon is sub-divided into 3 segments and is dilated in 3 stages. First, the
2621:
1577:
1300:
1225:
1066:
1412:
Abascal, V. M.; Wilkins, G. T.; O'Shea, J. P.; Choong, C. Y.; Palacios, I. F.; Thomas, J. D.; Rosas, E.; Newell, J. B.; et al. (1990).
2255:
2064:
1901:
447:
of the left atrium will cause the left atrium to increase in size. As the left atrium increases in size, it becomes more prone to develop
2069:
2059:
1648:
2757:
2716:
2674:
2366:
2197:
1811:
1321:
2614:
2237:
1001:
484:
302:
2934:
2232:
715:, which shows left atrial enlargement, thick and calcified mitral valve with narrow and "fish-mouth"-shaped orifice and signs of
1291:
Kasper, Dennis L.; Fauci, Anthony S.; Hauser, Stephen L.; Longo, Dan L.; Larry
Jameson, J.; Loscalzo, Joseph (6 February 2018).
3137:
2939:
2829:
2101:
1882:
1108:
719:
in advanced disease. It can also show decreased opening of the mitral valve leaflets, and increased blood flow velocity during
193:
is a common complication of resulting left atrial enlargement, which can lead to systemic thromboembolic complications such as
2749:
2177:
2172:
2096:
1896:
772:, that is, broad, notched P waves in several or many leads with a prominent late negative component to the P wave in lead V
2824:
2691:
2662:
2523:
2399:
2328:
2160:
736:
2654:
2518:
2311:
2294:
2227:
2147:
1526:
914:
357:
229:
2361:
42:
1806:
2343:
1831:
1816:
2667:
2118:
2731:
2721:
2421:
2086:
2013:
1740:
1132:
Nano-analytical electron microscopy reveals fundamental insights into human cardiovascular tissue calcification.
740:
716:
565:
557:
2371:
253:
in later stages when the left atrial volume is increased (i.e., dilation). The latter leads to increase risk of
3061:
2851:
2819:
2545:
2301:
2091:
1988:
1969:
1799:
1572:
796:
433:
342:
294:
with medical therapy alone was 44 ± 6% at 5 years, and 32 ± 8% at 10 years after they were offered correction.
154:
2976:
2846:
2637:
2578:
2552:
2540:
2528:
2513:
2247:
2189:
1993:
1974:
1626:
1566:
1519:
1502:
759:
334:
306:
186:
123:
2799:
2778:
2167:
2133:
2076:
2054:
1876:
1858:
1794:
1661:
1614:
1542:
577:
508:
417:
353:
170:
2986:
2889:
2879:
2698:
1931:
1926:
1821:
1631:
466:
Mitral stenosis typically progresses slowly (over decades) from the initial signs of mitral stenosis to
377:
The normal area of the mitral valve orifice is about 4 to 6 cm. In normal cardiac physiology, the
368:
2906:
2884:
2856:
2785:
2708:
2427:
1955:
1936:
1836:
1747:
1690:
1090:
777:
724:
425:
158:
876:
205:
3042:
2739:
2645:
2432:
2289:
2284:
2207:
2111:
2081:
2040:
1666:
1583:
1414:"Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy"
765:
636:
615:
448:
254:
221:
190:
144:
2535:
2333:
2155:
2106:
1731:
1678:
1588:
906:
898:
810:
The indication for invasive treatment with either a mitral valve replacement or valvuloplasty is
516:
78:
257:, which increases the risk of blood stasis (motionless). This increases the risk of coagulation.
934:
restenosis 10 years following the procedure. The number falls to about 40% 15 years post-PBMV.
735:
Another method of measuring the severity of mitral stenosis is the simultaneous left and right
3101:
3072:
2841:
2595:
2446:
2404:
2319:
2137:
2035:
1752:
1695:
1593:
1463:
1435:
1394:
1296:
1221:
1196:
1062:
997:
974:
890:
622:
561:
497:
444:
432:, leading to extravasation of fluid from the vascular tree and pooling of fluid in the lungs (
318:
130:
66:
54:
2971:
2966:
2568:
2460:
2353:
2049:
1425:
1384:
1376:
1186:
1178:
964:
866:
830:
804:
712:
550:
429:
140:
1318:
2961:
2836:
2814:
2590:
1982:
1963:
1950:
1757:
1636:
1325:
1051:
Chapter 1: Diseases of the
Cardiovascular system > Section: Valvular Heart Disease in:
919:
838:
437:
330:
284:
250:
119:
1492:
2583:
2491:
2389:
2381:
2279:
1789:
1782:
1769:
1389:
1364:
1191:
1166:
1055:
818:
409:
397:
382:
3055:
3051:
3047:
969:
952:
3131:
2929:
2773:
2573:
2484:
1619:
1338:
870:
854:
356:
where the vegetations may favor increase risk of stenosis. Other rare causes include
338:
268:
217:
3112:
1104:
2951:
2896:
2874:
2505:
2479:
2323:
2271:
1944:
1920:
1890:
1867:
1736:
1726:
902:
894:
848:
844:
834:
800:
632:
609:
581:
569:
546:
539:
493:
460:
378:
314:
235:
178:
3066:
1511:
1215:
329:
Almost all cases of mitral stenosis are due to disease in the heart secondary to
3096:
2944:
2440:
2338:
2128:
2045:
2027:
1853:
1826:
1777:
1718:
1214:
Bonow, Robert O.; Mann, Douglas L.; Zipes, Douglas P.; Peter Libby M.D. (2012).
1182:
825:
Treatment also focuses on concomitant conditions often seen in mitral stenosis:
755:
597:
393:
136:
88:
51:
3115:
3077:
3032:
3028:
3024:
2956:
2468:
2018:
526:
An opening snap that is a high-pitch additional sound may be heard after the A
405:
322:
245:
240:
96:
71:
17:
3107:
1430:
1413:
501:
421:
346:
225:
2606:
1467:
1363:
Wilkins, G T; Weyman, A E; Abascal, V M; Block, P C; Palacios, I F (1988).
1200:
978:
723:. The trans-mitral gradient as measured by Doppler echocardiography is the
1439:
1398:
2394:
1551:
1380:
918:
the valve and causes congestion, leading to circulatory arrest and flash
910:
862:
744:
720:
625:- presence of right ventricular hypertrophy due to pulmonary hypertension
535:
385:
174:
3007:
858:
711:
In most cases, the diagnosis of mitral stenosis is most easily made by
573:
310:
260:
58:
3019:
2474:
2454:
1609:
290:
In individuals having been offered mitral valve surgery but refused,
194:
847:
is treated aggressively, but caution must be taken in administering
780:, and, potentially, any cause of overload of the left atrium. Thus,
1105:"Mitral Stenosis: Heart Valve Disorders: Merck Manual Home Edition"
875:
869:
and, if not contraindicated, cautious inpatient administration of
483:
389:
367:
301:
264:
204:
182:
618:- irregular pulse and loss of 'a' wave in jugular venous pressure
1267:"Mitral Stenosis: Valvular Disorders: Merck Manual Professional"
1217:
Braunwald's Heart
Disease: A Textbook of Cardiovascular Medicine
2610:
1515:
1148:
Miller, J. D. Cardiovascular calcification: Orbicular origins.
85:
dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea
209:
Illustration of mitral stenosis, with close-up on mitral valve
893:, a catheter with a special balloon is passed from the right
213:
Signs and symptoms of mitral stenosis include the following:
275:
Fatigue and weakness increase with exercise and pregnancy.
50:
Mitral stenosis with marked thickening of the leaflets and
600:- due to back pressure and buildup of carbon dioxide (CO
590:
Almost all signs increase with exercise and pregnancy.
424:
pressures in this level cause an imbalance between the
727:
in the evaluation of the severity of mitral stenosis.
488:
Phonocardiograms from normal and abnormal heart sounds
1061:. Hagerstwon, MD: Lippincott Williams & Wilkins.
792:
Treatment is not necessary in asymptomatic patients.
739:. The right heart catheterization (commonly known as
2997:
1328:
Citing. Stedman's
Medical Dictionary. Copyright 2006
930:
leading to cardiac tamponade or serious blood loss.
283:
The natural history of mitral stenosis secondary to
3087:
3001:
2921:
2867:
2807:
2798:
2766:
2748:
2730:
2707:
2653:
2644:
2561:
2504:
2413:
2380:
2352:
2310:
2269:
2246:
2220:
2188:
2146:
2127:
2026:
2012:
1912:
1866:
1852:
1768:
1717:
1710:
1647:
1602:
1559:
1550:
150:
129:
115:
77:
65:
35:
1054:
795:The treatment options for mitral stenosis include
345:. It is the most common valvular heart disease in
1047:
1045:
1043:
1041:
1039:
1037:
1035:
1033:
553:. Its duration increases with worsening disease.
1053:Elizabeth D Agabegi; Agabegi, Steven S. (2008).
1031:
1029:
1027:
1025:
1023:
1021:
1019:
1017:
1015:
1013:
530:(aortic) component of the second heart sound (S
341:of the mitral valve leaflets, and as a form of
2622:
1527:
1083:"Los 13 mejores consejos para dejar de fumar"
511:secondary to mitral stenosis is severe, the P
500:is usually loud and may be palpable (tapping
8:
2982:Anomalous aortic origin of a coronary artery
1165:Gelson, E; Gatzoulis, M; Johnson, M (2007).
1314:
1312:
556:Advanced disease may present with signs of
496:of an individual with mitral stenosis, the
2998:
2804:
2650:
2629:
2615:
2607:
2143:
2023:
1863:
1844:Arrhythmogenic right ventricular dysplasia
1714:
1556:
1534:
1520:
1512:
1293:Harrison's principles of internal medicine
580:, the latter often presenting with a loud
41:
32:
1429:
1388:
1190:
968:
337:. Uncommon causes of mitral stenosis are
829:Any angina is treated with short-acting
659:
313:with characteristic findings (thickened
943:
628:Tapping apex beat that is not displaced
1578:Spontaneous coronary artery dissection
1252:
1250:
1248:
1246:
996:. Churchill Livingstone. p. 616.
953:"Modern Management of Mitral Stenosis"
758:may also assist in diagnosis, showing
455:and sudden congestive heart failure.
27:Heart disease with narrowing of valve
7:
1902:Nonbacterial thrombotic endocarditis
1343:The Lecturio Medical Concept Library
1057:Step-Up to Medicine (Step-Up Series)
880:Illustration of mitral valvuloplasty
459:addition, when AF sets in, systemic
994:Principles and Practice of Medicine
2717:Sinus venosus atrial septal defect
2675:Transposition of the great vessels
2198:Accelerated idioventricular rhythm
1456:The Journal of Heart Valve Disease
25:
970:10.1161/CIRCULATIONAHA.104.532498
321:, hypertrophied left ventricular
3143:Chronic rheumatic heart diseases
1485:
784:may be a more appropriate term.
593:Other peripheral signs include:
267:and hepatomegaly (if right-side
187:rheumatic valvular heart disease
185:. It is almost always caused by
1883:Subacute bacterial endocarditis
1295:(20th ed.). p. 1815.
1273:from the original on 2014-08-19
1111:from the original on 2009-03-02
731:Cardiac chamber catheterization
101:Ascites, edema and hepatomegaly
2750:Atrioventricular septal defect
1319:medilexicon.com < P mitrale
1:
2692:Persistent truncus arteriosus
2663:Double outlet right ventricle
2400:Pulseless electrical activity
2329:Multifocal atrial tachycardia
2203:Catecholaminergic polymorphic
737:heart chamber catheterization
2655:Aortopulmonary septal defect
699:Very severe mitral stenosis
677:Progressive mitral stenosis
661:Severity of mitral stenosis
515:(pulmonic) component of the
358:mitral annular calcification
230:paroxysmal nocturnal dyspnea
1183:10.1136/bmj.39365.655833.AE
3159:
2344:Wandering atrial pacemaker
1891:non-infective endocarditis
1832:Endocardial fibroelastosis
992:Davidson, Stanley (2014).
776:, and may also be seen in
666:Degree of mitral stenosis
2732:Ventricular septal defect
2422:hexaxial reference system
2367:Jervell and Lange-Nielsen
1897:Libman–Sacks endocarditis
951:Carabello, B. A. (2005).
741:Swan-Ganz catheterization
717:right ventricular failure
566:jugular venous distension
558:right-sided heart failure
545:A mid-diastolic rumbling
49:
40:
2638:Congenital heart defects
2302:Ventricular fibrillation
1573:Coronary artery aneurysm
1167:"Valvular heart disease"
803:mitral valvuloplasty by
797:mitral valve replacement
434:congestive heart failure
343:congenital heart disease
155:Mitral valve replacement
2977:Coronary artery anomaly
2579:Diastolic heart failure
2553:Athletic heart syndrome
2514:Ventricular hypertrophy
2248:Pre-excitation syndrome
2102:Left posterior fascicle
1627:Acute coronary syndrome
1567:Coronary artery disease
1431:10.1161/01.CIR.82.2.448
760:left atrial enlargement
688:Severe mitral stenosis
551:bell of the stethoscope
463:becomes a real danger.
335:rheumatic heart disease
307:Rheumatic heart disease
124:rheumatic heart disease
3138:Valvular heart disease
2800:Valvular heart disease
2779:Cyanotic heart disease
2722:Lutembacher's syndrome
2097:Left anterior fascicle
1877:infective endocarditis
1662:Hibernating myocardium
1543:Cardiovascular disease
1240:American Heart Journal
881:
578:pulmonary hypertension
538:(after closure of the
509:pulmonary hypertension
489:
418:pulmonary hypertension
374:
354:infective endocarditis
326:
210:
177:of the opening of the
171:valvular heart disease
135:Physical Examination,
2987:Ventricular inversion
2699:Aortopulmonary window
2668:Taussig–Bing syndrome
2261:Wolff–Parkinson–White
2221:Premature contraction
2119:Adams–Stokes syndrome
1822:Loeffler endocarditis
1632:Myocardial infarction
1220:. Elsevier Saunders.
909:is punctured and the
879:
812:NYHA functional class
487:
468:NYHA functional class
371:
352:Other causes include
305:
208:
173:characterized by the
2786:Eisenmenger syndrome
2709:Atrial septal defect
2428:Right axis deviation
2390:Sudden cardiac death
1748:Pericardial effusion
1691:Ventricular aneurysm
1381:10.1136/hrt.60.4.299
1269:. Merckmanuals.com.
885:Mitral valvuloplasty
814:III or IV symptoms.
778:mitral regurgitation
523:) will become loud.
480:Physical examination
426:hydrostatic pressure
159:mitral valvuloplasty
2740:Tetralogy of Fallot
2646:Heart septal defect
2433:Left axis deviation
2290:Atrial fibrillation
2285:Ventricular flutter
2208:Torsades de pointes
2082:Bundle branch block
2041:Sick sinus syndrome
1827:Cardiac amyloidosis
1812:Tachycardia-induced
1667:Myocardial stunning
1615:Prinzmetal's angina
1584:Coronary thrombosis
766:Electrocardiography
662:
637:atrial fibrillation
616:Atrial fibrillation
449:atrial fibrillation
333:and the consequent
255:atrial fibrillation
222:dyspnea on exertion
191:Atrial fibrillation
145:Electrocardiography
3088:External resources
2536:Atrial enlargement
2334:Pacemaker syndrome
2256:Lown–Ganong–Levine
2178:Junctional ectopic
2173:AV nodal reentrant
1679:Myocardial rupture
1589:Coronary vasospasm
1324:2011-11-03 at the
907:interatrial septum
899:inferior vena cava
882:
782:P-sinistrocardiale
672:Mitral valve area
660:
647:Associated lesions
517:second heart sound
490:
375:
327:
220:symptoms, such as
211:
201:Signs and symptoms
3125:
3124:
2995:
2994:
2917:
2916:
2857:Ebstein's anomaly
2794:
2793:
2604:
2603:
2596:Obstructive shock
2500:
2499:
2447:Short QT syndrome
2414:Other / ungrouped
2405:Sinoatrial arrest
2320:Ectopic pacemaker
2216:
2215:
2036:Sinus bradycardia
2008:
2007:
2004:
2003:
1753:Cardiac tamponade
1706:
1705:
1696:Dressler syndrome
1594:Myocardial bridge
1339:"Mitral Stenosis"
1302:978-1-25-964404-7
1227:978-1-4377-0398-6
1155:, 476-478 (2013).
1139:, 576-583 (2013).
1134:Nature Materials
1068:978-0-7817-7153-5
891:local anaesthetic
867:nitrovasodilators
831:nitrovasodilators
819:echocardiographic
709:
708:
705:< 1.0 cm
623:parasternal heave
562:parasternal heave
498:first heart sound
445:pressure overload
392:to flow from the
319:chordae tendineae
164:
163:
131:Diagnostic method
57:. Superior view.
30:Medical condition
16:(Redirected from
3150:
2999:
2972:Brugada syndrome
2967:Crisscross heart
2837:tricuspid valves
2815:pulmonary valves
2805:
2651:
2631:
2624:
2617:
2608:
2569:Cardiac fibrosis
2461:T wave alternans
2354:Long QT syndrome
2148:Supraventricular
2144:
2077:Intraventricular
2024:
1864:
1715:
1560:Coronary disease
1557:
1536:
1529:
1522:
1513:
1489:
1488:
1472:
1471:
1450:
1444:
1443:
1433:
1409:
1403:
1402:
1392:
1360:
1354:
1353:
1351:
1349:
1335:
1329:
1316:
1307:
1306:
1288:
1282:
1281:
1279:
1278:
1263:
1257:
1254:
1241:
1238:
1232:
1231:
1211:
1205:
1204:
1194:
1177:(7628): 1042–5.
1162:
1156:
1150:Nature Materials
1146:
1140:
1126:
1120:
1119:
1117:
1116:
1101:
1095:
1094:
1089:. Archived from
1079:
1073:
1072:
1060:
1049:
1008:
1007:
989:
983:
982:
972:
948:
857:is treated with
839:calcium blockers
805:balloon catheter
799:by surgery, and
751:Other techniques
713:echocardiography
694:1.0–1.5 cm
683:>1.5 cm
663:
656:Echocardiography
430:oncotic pressure
383:left ventricular
141:Echocardiography
45:
33:
21:
3158:
3157:
3153:
3152:
3151:
3149:
3148:
3147:
3128:
3127:
3126:
3121:
3120:
3083:
3082:
3010:
2996:
2991:
2962:Cor triatriatum
2928:Underdeveloped
2913:
2863:
2790:
2762:
2744:
2726:
2703:
2640:
2635:
2605:
2600:
2591:Rheumatic fever
2557:
2496:
2409:
2376:
2348:
2306:
2265:
2242:
2212:
2184:
2131:
2123:
2017:
2000:
1908:
1857:
1848:
1764:
1758:Hemopericardium
1702:
1643:
1637:Unstable angina
1610:Angina pectoris
1603:Active ischemia
1598:
1546:
1540:
1510:
1509:
1508:
1503:Mitral stenosis
1490:
1486:
1481:
1476:
1475:
1452:
1451:
1447:
1411:
1410:
1406:
1362:
1361:
1357:
1347:
1345:
1337:
1336:
1332:
1326:Wayback Machine
1317:
1310:
1303:
1290:
1289:
1285:
1276:
1274:
1265:
1264:
1260:
1255:
1244:
1239:
1235:
1228:
1213:
1212:
1208:
1164:
1163:
1159:
1147:
1143:
1127:
1123:
1114:
1112:
1103:
1102:
1098:
1081:
1080:
1076:
1069:
1052:
1050:
1011:
1004:
991:
990:
986:
950:
949:
945:
940:
920:pulmonary edema
887:
790:
775:
753:
733:
658:
649:
607:
603:
585:
533:
529:
522:
514:
482:
477:
438:pulmonary edema
366:
364:Pathophysiology
331:rheumatic fever
300:
285:rheumatic fever
281:
279:Natural history
251:Thromboembolism
203:
167:Mitral stenosis
120:rheumatic fever
109:Thromboembolism
36:Mitral stenosis
31:
28:
23:
22:
15:
12:
11:
5:
3156:
3154:
3146:
3145:
3140:
3130:
3129:
3123:
3122:
3119:
3118:
3104:
3092:
3091:
3089:
3085:
3084:
3081:
3080:
3069:
3058:
3035:
3011:
3006:
3005:
3003:
3002:Classification
2993:
2992:
2990:
2989:
2984:
2979:
2974:
2969:
2964:
2959:
2954:
2949:
2948:
2947:
2942:
2937:
2930:heart chambers
2925:
2923:
2919:
2918:
2915:
2914:
2912:
2911:
2910:
2909:
2904:
2894:
2893:
2892:
2887:
2882:
2871:
2869:
2865:
2864:
2862:
2861:
2860:
2859:
2854:
2849:
2844:
2834:
2833:
2832:
2827:
2822:
2811:
2809:
2802:
2796:
2795:
2792:
2791:
2789:
2788:
2783:
2782:
2781:
2770:
2768:
2764:
2763:
2761:
2760:
2754:
2752:
2746:
2745:
2743:
2742:
2736:
2734:
2728:
2727:
2725:
2724:
2719:
2713:
2711:
2705:
2704:
2702:
2701:
2695:
2694:
2689:
2688:
2687:
2682:
2672:
2671:
2670:
2659:
2657:
2648:
2642:
2641:
2636:
2634:
2633:
2626:
2619:
2611:
2602:
2601:
2599:
2598:
2593:
2588:
2587:
2586:
2584:Cardiac asthma
2581:
2571:
2565:
2563:
2559:
2558:
2556:
2555:
2550:
2549:
2548:
2543:
2533:
2532:
2531:
2526:
2521:
2510:
2508:
2502:
2501:
2498:
2497:
2495:
2494:
2492:Strain pattern
2489:
2488:
2487:
2482:
2477:
2465:
2464:
2463:
2451:
2450:
2449:
2437:
2436:
2435:
2430:
2417:
2415:
2411:
2410:
2408:
2407:
2402:
2397:
2392:
2386:
2384:
2382:Cardiac arrest
2378:
2377:
2375:
2374:
2369:
2364:
2362:Andersen–Tawil
2358:
2356:
2350:
2349:
2347:
2346:
2341:
2336:
2331:
2326:
2316:
2314:
2308:
2307:
2305:
2304:
2299:
2298:
2297:
2287:
2282:
2280:Atrial flutter
2276:
2274:
2267:
2266:
2264:
2263:
2258:
2252:
2250:
2244:
2243:
2241:
2240:
2235:
2230:
2224:
2222:
2218:
2217:
2214:
2213:
2211:
2210:
2205:
2200:
2194:
2192:
2186:
2185:
2183:
2182:
2181:
2180:
2175:
2165:
2164:
2163:
2152:
2150:
2141:
2125:
2124:
2122:
2121:
2116:
2115:
2114:
2109:
2104:
2099:
2094:
2089:
2079:
2074:
2073:
2072:
2067:
2062:
2052:
2043:
2038:
2032:
2030:
2021:
2010:
2009:
2006:
2005:
2002:
2001:
1999:
1998:
1997:
1996:
1991:
1979:
1978:
1977:
1972:
1960:
1959:
1958:
1953:
1941:
1940:
1939:
1934:
1929:
1916:
1914:
1910:
1909:
1907:
1906:
1905:
1904:
1899:
1887:
1886:
1885:
1872:
1870:
1861:
1850:
1849:
1847:
1846:
1841:
1840:
1839:
1834:
1829:
1824:
1819:
1814:
1809:
1804:
1803:
1802:
1790:Cardiomyopathy
1787:
1786:
1785:
1783:Chagas disease
1774:
1772:
1766:
1765:
1763:
1762:
1761:
1760:
1755:
1745:
1744:
1743:
1734:
1723:
1721:
1712:
1708:
1707:
1704:
1703:
1701:
1700:
1699:
1698:
1693:
1683:
1682:
1681:
1671:
1670:
1669:
1664:
1653:
1651:
1645:
1644:
1642:
1641:
1640:
1639:
1634:
1624:
1623:
1622:
1617:
1606:
1604:
1600:
1599:
1597:
1596:
1591:
1586:
1581:
1575:
1570:
1563:
1561:
1554:
1548:
1547:
1541:
1539:
1538:
1531:
1524:
1516:
1491:
1484:
1483:
1482:
1480:
1479:External links
1477:
1474:
1473:
1445:
1404:
1375:(4): 299–308.
1355:
1330:
1308:
1301:
1283:
1258:
1242:
1233:
1226:
1206:
1157:
1141:
1121:
1096:
1093:on 2016-11-13.
1087:cursoenarm.net
1074:
1067:
1009:
1002:
984:
942:
941:
939:
936:
886:
883:
874:
873:
871:ACE inhibitors
851:
841:
789:
786:
773:
752:
749:
732:
729:
707:
706:
703:
700:
696:
695:
692:
689:
685:
684:
681:
678:
674:
673:
670:
669:Mean gradient
667:
657:
654:
648:
645:
630:
629:
626:
619:
613:
605:
601:
583:
531:
527:
520:
512:
481:
478:
476:
473:
410:cardiac output
398:left ventricle
365:
362:
299:
296:
280:
277:
273:
272:
258:
248:
243:
238:
233:
202:
199:
162:
161:
152:
148:
147:
133:
127:
126:
117:
113:
112:
111:
110:
103:
102:
99:
94:
91:
86:
81:
75:
74:
69:
63:
62:
47:
46:
38:
37:
29:
26:
24:
18:Mitral atresia
14:
13:
10:
9:
6:
4:
3:
2:
3155:
3144:
3141:
3139:
3136:
3135:
3133:
3117:
3114:
3110:
3109:
3105:
3103:
3099:
3098:
3094:
3093:
3090:
3086:
3079:
3075:
3074:
3070:
3068:
3064:
3063:
3059:
3057:
3053:
3049:
3045:
3044:
3040:
3036:
3034:
3030:
3026:
3022:
3021:
3017:
3013:
3012:
3009:
3004:
3000:
2988:
2985:
2983:
2980:
2978:
2975:
2973:
2970:
2968:
2965:
2963:
2960:
2958:
2955:
2953:
2950:
2946:
2943:
2941:
2938:
2936:
2933:
2932:
2931:
2927:
2926:
2924:
2920:
2908:
2907:regurgitation
2905:
2903:
2900:
2899:
2898:
2897:mitral valves
2895:
2891:
2888:
2886:
2885:insufficiency
2883:
2881:
2878:
2877:
2876:
2875:aortic valves
2873:
2872:
2870:
2866:
2858:
2855:
2853:
2850:
2848:
2847:regurgitation
2845:
2843:
2840:
2839:
2838:
2835:
2831:
2828:
2826:
2825:insufficiency
2823:
2821:
2818:
2817:
2816:
2813:
2812:
2810:
2806:
2803:
2801:
2797:
2787:
2784:
2780:
2777:
2776:
2775:
2774:Cardiac shunt
2772:
2771:
2769:
2765:
2759:
2758:Ostium primum
2756:
2755:
2753:
2751:
2747:
2741:
2738:
2737:
2735:
2733:
2729:
2723:
2720:
2718:
2715:
2714:
2712:
2710:
2706:
2700:
2697:
2696:
2693:
2690:
2686:
2683:
2681:
2678:
2677:
2676:
2673:
2669:
2666:
2665:
2664:
2661:
2660:
2658:
2656:
2652:
2649:
2647:
2643:
2639:
2632:
2627:
2625:
2620:
2618:
2613:
2612:
2609:
2597:
2594:
2592:
2589:
2585:
2582:
2580:
2577:
2576:
2575:
2574:Heart failure
2572:
2570:
2567:
2566:
2564:
2560:
2554:
2551:
2547:
2544:
2542:
2539:
2538:
2537:
2534:
2530:
2527:
2525:
2522:
2520:
2517:
2516:
2515:
2512:
2511:
2509:
2507:
2503:
2493:
2490:
2486:
2485:ST depression
2483:
2481:
2478:
2476:
2473:
2472:
2471:
2470:
2466:
2462:
2459:
2458:
2457:
2456:
2452:
2448:
2445:
2444:
2443:
2442:
2438:
2434:
2431:
2429:
2426:
2425:
2424:
2423:
2419:
2418:
2416:
2412:
2406:
2403:
2401:
2398:
2396:
2393:
2391:
2388:
2387:
2385:
2383:
2379:
2373:
2370:
2368:
2365:
2363:
2360:
2359:
2357:
2355:
2351:
2345:
2342:
2340:
2337:
2335:
2332:
2330:
2327:
2325:
2321:
2318:
2317:
2315:
2313:
2309:
2303:
2300:
2296:
2293:
2292:
2291:
2288:
2286:
2283:
2281:
2278:
2277:
2275:
2273:
2268:
2262:
2259:
2257:
2254:
2253:
2251:
2249:
2245:
2239:
2236:
2234:
2231:
2229:
2226:
2225:
2223:
2219:
2209:
2206:
2204:
2201:
2199:
2196:
2195:
2193:
2191:
2187:
2179:
2176:
2174:
2171:
2170:
2169:
2166:
2162:
2159:
2158:
2157:
2154:
2153:
2151:
2149:
2145:
2142:
2139:
2135:
2130:
2126:
2120:
2117:
2113:
2112:Trifascicular
2110:
2108:
2105:
2103:
2100:
2098:
2095:
2093:
2090:
2088:
2085:
2084:
2083:
2080:
2078:
2075:
2071:
2068:
2066:
2063:
2061:
2058:
2057:
2056:
2053:
2051:
2047:
2044:
2042:
2039:
2037:
2034:
2033:
2031:
2029:
2025:
2022:
2020:
2015:
2011:
1995:
1994:regurgitation
1992:
1990:
1987:
1986:
1985:
1984:
1980:
1976:
1975:regurgitation
1973:
1971:
1968:
1967:
1966:
1965:
1961:
1957:
1956:regurgitation
1954:
1952:
1949:
1948:
1947:
1946:
1942:
1938:
1937:regurgitation
1935:
1933:
1930:
1928:
1925:
1924:
1923:
1922:
1918:
1917:
1915:
1911:
1903:
1900:
1898:
1895:
1894:
1893:
1892:
1888:
1884:
1881:
1880:
1879:
1878:
1874:
1873:
1871:
1869:
1865:
1862:
1860:
1855:
1851:
1845:
1842:
1838:
1835:
1833:
1830:
1828:
1825:
1823:
1820:
1818:
1815:
1813:
1810:
1808:
1805:
1801:
1798:
1797:
1796:
1793:
1792:
1791:
1788:
1784:
1781:
1780:
1779:
1776:
1775:
1773:
1771:
1767:
1759:
1756:
1754:
1751:
1750:
1749:
1746:
1742:
1738:
1735:
1733:
1730:
1729:
1728:
1725:
1724:
1722:
1720:
1716:
1713:
1709:
1697:
1694:
1692:
1689:
1688:
1687:
1684:
1680:
1677:
1676:
1675:
1672:
1668:
1665:
1663:
1660:
1659:
1658:
1655:
1654:
1652:
1650:
1646:
1638:
1635:
1633:
1630:
1629:
1628:
1625:
1621:
1620:Stable angina
1618:
1616:
1613:
1612:
1611:
1608:
1607:
1605:
1601:
1595:
1592:
1590:
1587:
1585:
1582:
1579:
1576:
1574:
1571:
1568:
1565:
1564:
1562:
1558:
1555:
1553:
1549:
1544:
1537:
1532:
1530:
1525:
1523:
1518:
1517:
1514:
1506:
1505:
1504:
1498:
1494:
1478:
1469:
1465:
1462:(5): 454–60.
1461:
1457:
1449:
1446:
1441:
1437:
1432:
1427:
1424:(2): 448–56.
1423:
1419:
1415:
1408:
1405:
1400:
1396:
1391:
1386:
1382:
1378:
1374:
1370:
1366:
1359:
1356:
1344:
1340:
1334:
1331:
1327:
1323:
1320:
1315:
1313:
1309:
1304:
1298:
1294:
1287:
1284:
1272:
1268:
1262:
1259:
1253:
1251:
1249:
1247:
1243:
1237:
1234:
1229:
1223:
1219:
1218:
1210:
1207:
1202:
1198:
1193:
1188:
1184:
1180:
1176:
1172:
1168:
1161:
1158:
1154:
1151:
1145:
1142:
1138:
1135:
1131:
1125:
1122:
1110:
1106:
1100:
1097:
1092:
1088:
1084:
1078:
1075:
1070:
1064:
1059:
1058:
1048:
1046:
1044:
1042:
1040:
1038:
1036:
1034:
1032:
1030:
1028:
1026:
1024:
1022:
1020:
1018:
1016:
1014:
1010:
1005:
1003:9780702050473
999:
995:
988:
985:
980:
976:
971:
966:
962:
958:
954:
947:
944:
937:
935:
931:
927:
923:
921:
916:
912:
908:
904:
901:and into the
900:
896:
892:
884:
878:
872:
868:
864:
860:
856:
855:heart failure
852:
850:
849:beta-blockers
846:
842:
840:
836:
835:beta-blockers
832:
828:
827:
826:
823:
820:
815:
813:
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779:
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763:
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750:
748:
746:
742:
738:
730:
728:
726:
725:gold standard
722:
718:
714:
704:
702:> 10 mmHg
701:
698:
697:
693:
690:
687:
686:
682:
679:
676:
675:
671:
668:
665:
664:
655:
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646:
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640:
638:
634:
633:Medical signs
627:
624:
620:
617:
614:
611:
608:is a natural
599:
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579:
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486:
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472:
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464:
462:
456:
452:
450:
446:
443:The constant
441:
439:
435:
431:
427:
423:
420:. Pulmonary
419:
413:
411:
407:
401:
399:
395:
391:
387:
384:
381:opens during
380:
370:
363:
361:
359:
355:
350:
348:
344:
340:
339:calcification
336:
332:
324:
320:
316:
312:
308:
304:
297:
295:
293:
288:
286:
278:
276:
270:
269:heart failure
266:
262:
259:
256:
252:
249:
247:
244:
242:
239:
237:
234:
231:
227:
223:
219:
218:Heart failure
216:
215:
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192:
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180:
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68:
64:
60:
56:
53:
48:
44:
39:
34:
19:
3106:
3095:
3071:
3060:
3037:
3014:
2952:Dextrocardia
2901:
2767:Consequences
2506:Cardiomegaly
2480:ST elevation
2467:
2453:
2439:
2420:
2324:Ectopic beat
2272:fibrillation
2107:Bifascicular
1981:
1962:
1943:
1919:
1889:
1875:
1868:Endocarditis
1807:Hypertrophic
1741:Constrictive
1727:Pericarditis
1685:
1673:
1656:
1501:
1500:
1499:profile for
1496:
1459:
1455:
1448:
1421:
1417:
1407:
1372:
1368:
1358:
1346:. Retrieved
1342:
1333:
1292:
1286:
1275:. Retrieved
1261:
1236:
1216:
1209:
1174:
1170:
1160:
1152:
1149:
1144:
1136:
1133:
1129:
1128:Bertazzo, S.
1124:
1113:. Retrieved
1099:
1091:the original
1086:
1077:
1056:
993:
987:
963:(3): 432–7.
960:
956:
946:
932:
928:
924:
903:right atrium
895:femoral vein
888:
845:hypertension
824:
816:
809:
801:percutaneous
794:
791:
781:
769:
764:
754:
734:
710:
650:
641:
631:
592:
589:
570:hepatomegaly
555:
544:
540:aortic valve
525:
506:
494:auscultation
491:
465:
461:embolization
457:
453:
442:
414:
402:
379:mitral valve
376:
351:
328:
317:, thickened
315:mitral valve
291:
289:
282:
274:
236:Palpitations
212:
179:mitral valve
166:
165:
105:Late Stage:
104:
89:Palpitations
61:preparation.
3097:MedlinePlus
2945:Uhl anomaly
2372:Romano–Ward
2339:Parasystole
2238:Ventricular
2190:Ventricular
2129:Tachycardia
2046:Heart block
2028:Bradycardia
1854:Endocardium
1817:Restrictive
1778:Myocarditis
1719:Pericardium
1418:Circulation
957:Circulation
756:Chest X-ray
680:<5 mmHg
610:vasodilator
598:Malar flush
394:left atrium
388:, to allow
137:Chest X-ray
55:hypertrophy
52:left atrial
3132:Categories
3073:DiseasesDB
2957:Levocardia
2270:Flutter /
2233:Junctional
2168:Junctional
2161:Multifocal
2134:paroxysmal
2050:Sinoatrial
2019:arrhythmia
2014:Conduction
1770:Myocardium
1277:2013-02-21
1115:2009-03-14
938:References
691:5–10 mmHg
406:heart rate
323:myocardium
246:Hemoptysis
241:Chest pain
97:Hemoptysis
93:Chest pain
72:Cardiology
3113:emerg/315
3108:eMedicine
2529:Pulmonary
2312:Pacemaker
1983:pulmonary
1964:tricuspid
1800:Alcoholic
1348:11 August
897:, up the
863:diuretics
788:Treatment
770:P mitrale
768:may show
639:include:
502:apex beat
475:Diagnosis
422:capillary
347:pregnancy
271:develops)
226:orthopnea
175:narrowing
151:Treatment
67:Specialty
3116:ped/2517
2902:stenosis
2890:bicuspid
2880:stenosis
2852:stenosis
2820:stenosis
2395:Asystole
2295:Familial
1989:stenosis
1970:stenosis
1951:stenosis
1932:stenosis
1927:prolapse
1649:Sequelae
1552:Ischemia
1468:17944115
1322:Archived
1271:Archived
1201:18007005
1109:Archived
979:16027271
911:catheter
745:diastole
721:diastole
560:such as
536:diastole
436:causing
428:and the
386:diastole
292:survival
79:Symptoms
3067:D008946
2842:atresia
2830:absence
1795:Dilated
1737:Chronic
1545:(heart)
1493:Scholia
1440:2372892
1399:3190958
1390:1216577
1192:2078629
859:digoxin
837:and/or
576:and/or
574:ascites
396:to the
311:autopsy
261:Ascites
181:of the
59:Autopsy
3102:000175
2680:dextro
2475:J wave
2228:Atrial
2156:Atrial
1945:aortic
1921:mitral
1913:Valves
1859:valves
1711:Layers
1580:(SCAD)
1495:has a
1466:
1438:
1397:
1387:
1299:
1224:
1199:
1189:
1130:et al.
1065:
1000:
977:
915:distal
905:. The
547:murmur
451:(AF).
373:valve.
195:stroke
116:Causes
3056:746.5
3052:396.0
3048:394.0
3033:Q23.2
3029:I34.2
3025:I05.0
2935:right
2922:Other
2808:Right
2562:Other
2546:Right
2524:Right
2138:sinus
2087:Right
1837:Viral
1732:Acute
1686:weeks
1657:hours
1569:(CAD)
1497:topic
1369:Heart
621:Left
604:). CO
492:Upon
390:blood
298:Cause
265:edema
232:(PND)
183:heart
169:is a
3078:8288
3062:MeSH
3043:9-CM
2940:left
2868:Left
2685:levo
2541:Left
2519:Left
2136:and
2092:Left
1674:days
1464:PMID
1436:PMID
1395:PMID
1350:2021
1297:ISBN
1222:ISBN
1197:PMID
1063:ISBN
998:ISBN
975:PMID
853:Any
843:Any
263:and
228:and
3050:,
3039:ICD
3016:ICD
1426:doi
1385:PMC
1377:doi
1187:PMC
1179:doi
1175:335
1171:BMJ
965:doi
961:112
635:of
507:If
440:).
408:or
309:at
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3111::
3100::
3076::
3065::
3054:,
3046::
3031:,
3027:,
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3020:10
2469:ST
2441:QT
2322:/
2070:3°
2065:2°
2060:1°
2055:AV
2048::
1739:/
1460:16
1458:.
1434:.
1422:82
1420:.
1416:.
1393:.
1383:.
1373:60
1371:.
1367:.
1341:.
1311:^
1245:^
1195:.
1185:.
1173:.
1169:.
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1137:12
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955:.
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