Journal of Cardiology Cases最新文献

{"title":"Amyloid and Anderson-Fabry disease: Can there be a CMR phenotypic overlap?","authors":"Saed Alnaimat MD ,&nbsp;Mariah Mascara MD ,&nbsp;Srijana Maharjan MD ,&nbsp;Abdallah Naser MD ,&nbsp;Valentyna Ivanova MD ,&nbsp;Moneal Shah MD ,&nbsp;Robert W.W. Biederman MD","doi":"10.1016/j.jccase.2024.12.005","DOIUrl":"10.1016/j.jccase.2024.12.005","url":null,"abstract":"<div><div>A 53-year-old female had an atypical presentation of cardiac amyloidosis on cardiac magnetic resonance imaging. As opposed to the usual diffuse heterogenous late gadolinium enhancement (LGE) seen in cases of cardiac amyloidosis, the patient had localized LGE in the inferolateral left ventricular wall classically resembling Anderson Fabry's disease. However, other cardiac magnetic resonance features raised the suspicion for cardiac amyloidosis which was later confirmed by endomyocardial biopsy. This case highlights that cardiac amyloidosis can have atypical imaging features that may lead to incorrect diagnosis. Clinicians should maintain a high index of suspicion and pay attention to certain supportive findings such as atrial wall thickening, valve leaflet thickening, pericardial effusion, as well as abnormal strain pattern.</div></div><div><h3>Learning objectives</h3><div><ul><li><span>•</span><span><div>Cardiac amyloidosis can have atypical imaging features and strain pattern that may lead to incorrect diagnosis.</div></span></li><li><span>•</span><span><div>Clinicians should maintain a high index of suspicion and pay attention to certain supportive findings such as atrial wall thickening, valve leaflet thickening, pericardial effusion, as well as abnormal strain pattern.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 4","pages":"Pages 109-112"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left atrial appendage occlusion devices: one size doesn't fit all? The turning point of a custom-made device","authors":"Silvia Maiani MD ,&nbsp;Giulia Nardi MD ,&nbsp;Miroslava Stolcova MD ,&nbsp;Francesca Ristalli MD ,&nbsp;Maria Federica Crociani MD ,&nbsp;Niccolò Ciardetti MD ,&nbsp;Alessio Mattesini MD ,&nbsp;Carlo Di Mario MD, PhD ,&nbsp;Francesco Meucci MD","doi":"10.1016/j.jccase.2024.12.001","DOIUrl":"10.1016/j.jccase.2024.12.001","url":null,"abstract":"<div><div>Left atrial appendage occlusion (LAAO) has as a comparable efficacy and safety profile compared with oral anticoagulation therapy in patients with atrial fibrillation. The procedural success rate is high, but some challenging anatomies may preclude optimal closure with standard devices. Our patient underwent a first LAAO attempt with Amplatzer Amulet 34 mm (St. Jude Medical, Saint Paul, MN, USA) and Watchman FLX 35 mm (Boston Scientific, Marlborough, MA, USA), but device anchoring was not feasible or sub-optimal due to the oversized LAA. The procedure was postponed in order to perform a cardiac computed tomography angiography and a custom-made LAmbre Closure System 42/52 mm (Lifetech Scientific, Shenzhen, China), specifically fitted with patient's LAA anatomy, was successfully implanted. The procedure was straightforward, and the device perfectly adapted to our patient's anatomy, with no residual leak.</div></div><div><h3>Learning objective</h3><div>Left atrial appendage presents several morphologies and procedural success rate of left atrial appendage occlusion is high, but challenging anatomies may preclude optimal closure with standard devices. Our case emphasizes the importance of pre-procedural planning and the safety and feasibility of custom-made devices, overcoming procedural failure of a previous attempt with standard devices.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 4","pages":"Pages 97-100"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic ECG change from de Winter to Wellens - Rare ECG change in acute coronary syndrome","authors":"Naoki Arima MD,&nbsp;Naohito Yamasaki MD, PhD,&nbsp;Tomoki Furushima MD,&nbsp;Yuya Miyamoto MD,&nbsp;Toshihiro Moriki MD,&nbsp;Kazuya Miyagawa MD,&nbsp;Tatsuya Noguchi MD, PhD,&nbsp;Toru Kubo MD, PhD, FJCC ,&nbsp;Hiroaki Kitaoka MD, PhD, FJCC","doi":"10.1016/j.jccase.2024.12.004","DOIUrl":"10.1016/j.jccase.2024.12.004","url":null,"abstract":"<div><div>A 70-year-old male complained of chest pain. His electrocardiogram (ECG) revealed the De Winter pattern, which indicates left anterior descending artery occlusion. His symptoms spontaneously resolved within 30 min. This time, his ECG showed Wellens's sign. It is rare to see a change from De Winter to Wellens in one patient.</div></div><div><h3>Learning objectives</h3><div>Recognize de Winter's and Wellens' electrocardiogram (ECG) patterns as high-risk ECG for acute coronary syndrome (ACS), specifically related to left anterior descending artery lesions. Obtain serial ECGs in ACS patients to detect newly emerging changes in the coronary artery.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 4","pages":"Pages 93-96"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of cytomegalovirus myocarditis complicating rejection after heart transplantation: Case report and review of literature","authors":"Raffaele Abete MD ,&nbsp;Attilio Iacovoni MD ,&nbsp;Claudia Vittori MD ,&nbsp;Roberta Sebastiani MD ,&nbsp;Elisabetta Candiago MD ,&nbsp;Andrea Gianatti MD ,&nbsp;Amedeo Terzi MD ,&nbsp;Michele Senni MD","doi":"10.1016/j.jccase.2024.12.007","DOIUrl":"10.1016/j.jccase.2024.12.007","url":null,"abstract":"<div><div>A 49-year-old female with terminal hypertrophic cardiomyopathy underwent orthotopic heart transplantation. The patient developed early acute rejection. Intensifying therapy led to improvement, but cytomegalovirus (CMV) myocarditis emerged. Aggressive management, including high-dose ganciclovir and intravenous immunoglobulin, resulted in negativization of CMV and rejection markers. Cardiac function recovered, emphasizing the challenges and successful multidisciplinary approach in managing complex post-transplant complications.</div></div><div><h3>Learning objectives</h3><div>To diagnose and treat complications in heart transplantation, such as opportunistic infections and cellular and/or antibody-mediated rejection. To underline role of endomyocardial biopsy in heart transplant monitoring.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 4","pages":"Pages 105-108"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal cell carcinoma with cardiac metastasis and near right heart obliteration: A case report","authors":"Maren Downing MEng ,&nbsp;Kristen M. Quinn MD ,&nbsp;Micheal Odle MD","doi":"10.1016/j.jccase.2025.01.004","DOIUrl":"10.1016/j.jccase.2025.01.004","url":null,"abstract":"<div><div>Renal cell carcinoma (RCC) is the most common type of primary kidney cancer with up to 30 % of patients having metastatic disease at the time of diagnosis. Metastasis to the heart is extremely rare with only a few cases ever reported. Most patients with cardiac metastases of any origin do not develop symptoms of cardiac dysfunction. The classic triad of presentation for RCC is hematuria, flank pain, and a palpable mass. We report a rare occurrence of cardiac involvement of RCC infiltrating both the right atrium and right ventricle in an otherwise healthy female patient whose presenting symptom was dyspnea. Dyspnea, although a vague presenting symptom with a large differential diagnosis, is the most common presenting symptom of cardiac tumors and a sudden presentation of dyspnea in a patient with RCC should encourage the consideration of cardiac metastasis. The importance of repeat imaging and cross-disciplinary care in a patient with RCC with cardiac involvement is well displayed. A delay in cancer diagnosis may lead to delay in therapy and the result may be associated with significant morbidity and mortality. Quick action including evaluation and treatment for RCC is imperative to increase the chance for survival.</div></div><div><h3>Learning objective</h3><div>Metastasis to the heart is extremely rare and most patients do not develop cardiac symptoms. Dyspnea is a vague presenting symptom requiring a broad differential to determine underlying pathology. Here, acute dyspnea in a patient with renal cell carcinoma was the presenting symptom of cardiac metastasis and continued repeat imaging in this patient with supplemental oxygen requirements showed fast spread into the right heart.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 4","pages":"Pages 117-120"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular fibrillation arrest with cardiomyopathy in the setting of exogenous T3 consumption in a previously healthy young male","authors":"Tobin Mathew MD ,&nbsp;Kevin S. Tang MD ,&nbsp;Fahad Gul MD ,&nbsp;Sareen Sandhu DO ,&nbsp;Omid Vadpey MD ,&nbsp;Qin Yang MD ,&nbsp;David Donaldson MD","doi":"10.1016/j.jccase.2025.01.002","DOIUrl":"10.1016/j.jccase.2025.01.002","url":null,"abstract":"<div><div>Ventricular fibrillation (VF) is an often-fatal cardiac arrhythmia with increased prevalence in those with structural heart disease, congestive heart failure, and history of myocardial infarction. Our case describes a young adult male who presented with VF arrest and new onset cardiomyopathy in the setting of exogenous testosterone and triiodothyronine supplementation. Comprehensive work-up demonstrated a severely reduced ejection fraction, no angiographically significant coronary artery disease on invasive coronary angiography, and evidence of right ventricular mid-lateral wall scarring on electrophysiology study and cardiac magnetic resonance imaging. Exogenous thyroid hormone and testosterone supplementation have been independently associated with development of dilated cardiomyopathy; however, VF arrest has rarely been described in otherwise previously healthy individuals with concomitant use of these substances. Optimal management, risk stratification, and prognosis in this population remains unknown. Our case identifies an at-risk population of sudden cardiac death where appropriate work-up and shared clinical decision-making is essential to improved patient outcomes and quality of life.</div></div><div><h3>Learning objective</h3><div>Exogenous triiodothyronine (T3) intake may be a risk factor for the development of acute cardiomyopathy, as cardiac myocytes directly uptake T3 which can induce arrhythmias and cardiac arrest. This process may be separate from tachycardia-mediated cardiomyopathy. Prognosis of hyperthyroid induced ventricular fibrillation and cardiomyopathy is unclear. Reversing the hyperthyroid state may reduce the risk of repeat sudden cardiac death. The decision for secondary prevention should be a joint decision understanding patient-specific risk factors and goals.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 4","pages":"Pages 113-116"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of hypertrophic obstructive cardiomyopathy with anomalous papillary muscle: A case report","authors":"Katsuya Kawagoe MD ,&nbsp;Koji Furukawa MD, PhD ,&nbsp;Hirohito Ishi MD ,&nbsp;Shuhei Sakaguchi MD ,&nbsp;Tomoaki Taniguchi MD ,&nbsp;Risa Meiri MD ,&nbsp;Yoshimasa Yamamura MD","doi":"10.1016/j.jccase.2024.12.006","DOIUrl":"10.1016/j.jccase.2024.12.006","url":null,"abstract":"<div><div>Anomalous papillary muscles (PMs), in which the PMs are directly attached to the anterior mitral valve (MV) leaflet, can cause obstruction of the left ventricular outflow tract (LVOT). Accurately diagnosing of anomalous PMs, understanding their pathology, and performing appropriate surgery are essential for relieving LVOT obstruction effectively.</div><div>A 71-year-old man with hypertrophic obstructive cardiomyopathy was referred to our hospital. Transthoracic echocardiography revealed LVOT obstruction with a peak outflow pressure gradient of 63 mm Hg at rest and 96 mm Hg during the Valsalva maneuver. Furthermore, an anomalous PM was suspected to be the cause of LVOT obstruction. Three- and four-dimensional cardiac computed tomography (CT) images clearly demonstrated that an anomalous PM from the anterior PMs was directly attached to the body of the anterior MV leaflet and that the anomalous PM, together with the thickened ventricular septum, caused a dynamic obstruction of the LVOT. We resected the anomalous PM from the anterior PMs and the subaortic ventricular septum using a transaortic approach.</div><div>In this case, preoperative three-dimensional and four-dimensional cardiac CT images were effective at revealing the presence of an anomalous PM and its pathology in patient with LVOT obstruction, leading to accurate and smooth surgical procedures and improved patient outcomes.</div></div><div><h3>Learning objective</h3><div><ul><li><span>•</span><span><div>Anomalous PMs are classified by their attachment patterns and appropriate surgical methods are recommended for each type, providing valuable insights for clinical decision-making.</div></span></li><li><span>•</span><span><div>This report emphasizes the significance of 3D and 4D cardiac CT in identifying the causes of LVOTO. This imaging technique provides important information regarding the location of the anomalous PM and dynamic impact, leading to a successful surgical outcome.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 4","pages":"Pages 101-104"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A young man diagnosed with chronic thromboembolic pulmonary hypertension after COVID-19 infection: A case report","authors":"Mitsumasa Akao MD,&nbsp;Kayoko Kubota MD, PhD,&nbsp;Sunao Miyanaga MD, PhD,&nbsp;Kokoro Mitsuyoshi MD,&nbsp;Mitsuru Ohishi MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.01.001","DOIUrl":"10.1016/j.jccase.2025.01.001","url":null,"abstract":"<div><div>Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease characterized by pulmonary hypertension (PH), resulting from stenosis or occlusion of the pulmonary arteries owing to an organic thrombus that obstructs blood flow in the pulmonary arteries. The prognosis for untreated patients is poor; however, it has improved significantly with the advent of treatments such as PH-targeted medical therapy and pulmonary balloon angioplasty, in addition to pulmonary endarterectomy. Nevertheless, the exact mechanisms underlying this disease remain unknown. Recently, a close association between coronavirus disease 2019 (COVID-19) and thrombosis has been detected, with the risk of venous thrombosis complications increasing after COVID-19 infection; however, few studies have reported on the association between COVID-19 and CTEPH. Herein, we present the case of a young man who developed CTEPH after a mild COVID-19 infection, despite the lack of an obvious thrombophilic predisposition. We conclude that if a patient develops chronic shortness of breath symptoms after a COVID-19 infection, it is important to investigate not only the COVID-19 sequelae, but also the presence of other diseases such as pulmonary artery thrombosis.</div></div><div><h3>Learning objective</h3><div>Coronavirus disease 2019 (COVID-19) infection frequently causes abnormal blood coagulation and is closely related to thrombosis. Although pulmonary embolism is a frequent complication of venous thrombosis, few studies have reported an association between COVID-19 and chronic thromboembolic pulmonary hypertension (CTEPH). Our patient developed CTEPH after COVID-19 infection. It is important to examine organic abnormalities, before diagnosing persistent dyspnea as a COVID-19 sequela.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 4","pages":"Pages 121-124"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of dilated cardiomyopathy successfully managing refractory electrical storm through sympathetic modulation","authors":"Phuong Ngo Thanh Nguyen MD ,&nbsp;Akiko Ueda MD ,&nbsp;Yumi Katsume MD ,&nbsp;Noriko Nonoguchi MD ,&nbsp;Takato Mohri MD ,&nbsp;Yoshifumi Hirata MD ,&nbsp;Haruhiko Kondo MD ,&nbsp;Kunitaro Watanabe MD ,&nbsp;Kyoko Soejima MD","doi":"10.1016/j.jccase.2024.11.008","DOIUrl":"10.1016/j.jccase.2024.11.008","url":null,"abstract":"<div><div>Recent research has demonstrated the effectiveness of cardiac sympathetic denervation in treating ventricular arrhythmias. We present a patient with dilated cardiomyopathy characterized by ventricular tachycardia (VT) resistant to standard treatments. Repeated left-sided stellate ganglion blocks provided temporary relief, followed by a thoracoscopic sympathectomy with T2–4 ganglionectomy, which significantly reduced the burden of VT. This intervention also allowed for the gradual reduction of antiarrhythmics. During the course of the hospital stay, the patient's activities of daily living steadily improved. Approximately one month following the surgical surgery, the patient was successfully discharged with a reduced burden of VT.</div></div><div><h3>Learning objective</h3><div>Evaluate the efficacy of cardiac sympathetic denervation (CSD) and ganglionectomy in treating refractory ventricular tachycardia in patients with dilated cardiomyopathy. Identify the potential advantages of CSD and ganglionectomy in avoiding the necessity for therapeutic escalation in refractory ventricular tachycardia cases.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 3","pages":"Pages 68-71"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complicated coronary artery dissection in which a guidewire was pushed out from the true lumen to the false lumen behind calcified plaque","authors":"Yusuke Watanabe MD, PhD,&nbsp;Kenichi Sakakura MD, PhD,&nbsp;Hiroyuki Jinnouchi MD, PhD,&nbsp;Hideo Fujita MD, PhD, FJCC","doi":"10.1016/j.jccase.2024.11.007","DOIUrl":"10.1016/j.jccase.2024.11.007","url":null,"abstract":"<div><div>Coronary artery dissection is a common complication in percutaneous coronary intervention (PCI). The bailout procedure from coronary artery dissection is relatively simple if a guidewire remains within the true lumen. However, if the guidewire migrates into a dissection cavity separated by a calcified plaque, the bailout procedure is more difficult even for experienced interventional cardiologists. In this case report, we provide a bailout procedure for complicated coronary artery dissection, in which the guidewire was pushed out from the true lumen to the false lumen behind calcified plaque. The knowledge of guidewire bias and intravascular ultrasound-guided PCI was useful and the technique to strengthen the back-up support was necessary for the successful bailout.</div></div><div><h3>Learning objective</h3><div>Guidewire migration into the false lumen behind a calcified plaque is a rare complication, but the knowledge of a bailout method using guidewire bias and intravascular ultrasound is important.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 3","pages":"Pages 72-75"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}