Journal of Cardiology Cases最新文献

{"title":"Aorto–right ventricular fistula with a prominent diastolic shunt flow after transcatheter aortic valve replacement: A unique case of a valve-cusp-regulated shunt flow","authors":"Abdullah Kaplan MD,&nbsp;Senem Has Hasirci MD,&nbsp;Serpil Eroglu MD,&nbsp;Alp Aydinalp MD","doi":"10.1016/j.jccase.2026.06.012","DOIUrl":"10.1016/j.jccase.2026.06.012","url":null,"abstract":"<div><div>Aorto-right ventricular fistula (ARVF) is a rare complication of transcatheter aortic valve replacement (TAVR) with limited evidence to guide its treatment. Five months following TAVR, an 82-year-old woman complained of edema and dyspnea. ARVF was confirmed by echocardiography, which revealed a shunt flow originating at the site of the prosthetic valve to the right ventricle. Unlike continuous shunt flow published in the literature, in this case the flow was observed distinctly during diastole. This situation was attributed to the prosthetic valve opening during systole, interrupting the shunt flow. After refusing invasive treatment, she was treated conservatively. As TAVR becomes more common, we will encounter this rare consequence more often. To determine the best management techniques for this rare condition, more research is required.</div></div><div><h3>Learning objective</h3><div>Aorto-right ventricular fistula (ARVF), a rare complication of transcatheter aortic valve replacement (TAVR), can manifest with varying localizations and hemodynamic characteristics. An ARVF with flow controlled by the aortic cusp is reported here for the first time. Patients post-TAVR should undergo long-term echocardiographic follow-up for ARVF as well.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 161-164"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078570","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":"Early recurrence of mitral annular calcification-related calcified amorphous tumor despite complete surgical resection","authors":"Yuto Hagiwara MD,&nbsp;Makoto Miyake MD, PhD,&nbsp;Shinji Sumiyoshi MD, PhD,&nbsp;Yu Noguchi MD,&nbsp;Shoko Nakagawa MD, PhD,&nbsp;Jiro Sakamoto MD, PhD,&nbsp;Hirokazu Kondo MD, PhD,&nbsp;Kyokun Uehara MD, PhD,&nbsp;Toshihiro Tamura MD, PhD","doi":"10.1016/j.jccase.2026.05.015","DOIUrl":"10.1016/j.jccase.2026.05.015","url":null,"abstract":"<div><div>Calcified amorphous tumor (CAT) is a non-neoplastic cardiac mass that rarely recurs after resection. We report a case of early recurrence of CAT despite complete surgical resection. A 59-year-old woman with end-stage renal disease and a recent cerebral infarction was found to have mobile masses attached to mitral annular calcification. The masses were surgically resected to prevent further embolic events, and histopathological examination confirmed the diagnosis of CAT. Follow-up echocardiography 7 months after surgery revealed recurrence, leading to a second resection. CAT can recur even in the early postoperative period; therefore, careful follow-up with echocardiography is essential for prompt detection of recurrence.</div></div><div><h3>Learning objective</h3><div>Although rare, calcified amorphous tumor can recur in the early postoperative period despite macroscopically complete resection. In particular, mitral annular calcification-related calcified amorphous tumor may grow rapidly, making careful postoperative follow-up essential. Echocardiography is an effective modality for monitoring and detecting recurrence.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 3","pages":"Pages 106-109"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859547","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":"Management of pericardial effusion with andexanet alfa during epicardial ventricular tachycardia ablation","authors":"Mayu Nakajima MD,&nbsp;Yasuyuki Takada MD, PhD,&nbsp;Muryo Terasawa MD, PhD,&nbsp;Kazuhiro Satomi MD, PhD,&nbsp;Yoshinao Yazaki MD, PhD","doi":"10.1016/j.jccase.2026.05.009","DOIUrl":"10.1016/j.jccase.2026.05.009","url":null,"abstract":"<div><div>Andexanet alfa, a reversal agent for factor Xa inhibitors, is rarely used during catheter ablation procedures. We describe a case in which andexanet alfa was effective to manage hemorrhagic pericardial effusion during epicardial ablation for ventricular tachycardia. After the administration of andexanet alfa, the therapeutic range of activated clotting times was difficult to achieve despite heparin administration. The procedure was completed safely by focusing on epicardial targets with minimal endocardial manipulation. Specific consideration of anticoagulation strategies is required in patients with hemorrhagic complications during ablation procedure.</div></div><div><h3>Learning objective</h3><div>This case presents the first reported use of andexanet alfa during catheter ablation for ventricular arrhythmias and emphasizes the importance of tailoring procedural strategies to each case, including consideration of the arrhythmogenic substrate location, to avoid thromboembolic complications.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 3","pages":"Pages 102-105"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859381","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":"Successful control of intractable Impella 5.5 graft site bleeding using a Viabahn stent graft: A case report","authors":"Seimei Kure MD, PhD,&nbsp;Taiichi Takasaki MD, PhD,&nbsp;Khoirur Rijal Ashsholih MD,&nbsp;Toshifumi Hiraoka MD, PhD,&nbsp;Shinya Takahashi MD, PhD","doi":"10.1016/j.jccase.2026.05.016","DOIUrl":"10.1016/j.jccase.2026.05.016","url":null,"abstract":"<div><div>Impella 5.5 (Abiomed Inc., Danvers, MA, USA) provides effective mechanical circulatory support in severe heart failure but requires surgical implantation via a prosthetic graft, which may be complicated by bleeding. We report a case of uncontrollable oozing hemorrhage at the axillary graft anastomosis site during Impella 5.5 support in a 35-year-old man with acute decompensated heart failure due to idiopathic cardiomyopathy. The patient had previously been supported with Impella CP, resulting in severe coagulopathy. To control the bleeding while preserving limb perfusion, a Viabahn covered stent (Vascutek Ltd, Inchinnan, United Kingdom) was deployed in the right subclavian artery to cover the graft anastomosis site, achieving immediate and complete hemostasis. After subsequent recovery of cardiac function, the Impella 5.5 was safely explanted. Viabahn stent graft placement may be an effective rescue strategy for intractable graft site bleeding during Impella 5.5 support when standard surgical hemostasis fails, allowing continuation of mechanical support and safe device removal.</div></div><div><h3>Learning objective</h3><div>Impella 5.5–related graft-site bleeding associated with coagulopathy after Impella CP or extracorporeal membrane oxygenation can be effectively controlled by Viabahn stent graft placement when conventional surgical hemostasis fails.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 3","pages":"Pages 122-124"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859552","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":"Acute coronary syndrome associated with probable immunoglobulin G4–related coronary periarteritis successfully treated with a drug-coated balloon","authors":"Takeshi Niizeki MD, PhD, FJCC,&nbsp;Tadateru Iwayama MD, PhD,&nbsp;Toshiki Sasaki MD, PhD","doi":"10.1016/j.jccase.2026.06.001","DOIUrl":"10.1016/j.jccase.2026.06.001","url":null,"abstract":"<div><div>Immunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory disorder that can rarely affect the coronary arteries, leading to acute coronary syndrome (ACS). A 68-year-old man with IgG4-RD presented with exertional chest pain. An electrocardiogram showing ST-segment elevation in II, III, aVF leads, and rising troponin levels confirmed ACS. Emergent coronary angiography (CAG) revealed right coronary artery occlusion, and intravascular ultrasound (IVUS) showed vasculitis-related coronary pathology. Based on these findings and the patient's clinical background, ACS secondary to IgG4-related coronary periarteritis (IgG4-related CP) was diagnosed. Because stent implantation for inflammation-associated lesions carries a high risk of restenosis, percutaneous coronary intervention (PCI) without stenting was performed. Plaque ablation was achieved using excimer laser coronary atherectomy, followed by angioplasty with a drug-coated balloon. Post-PCI coronary computed tomography angiography demonstrated perivascular soft tissue around the culprit lesion, suggestive of ongoing inflammation. Follow-up CAG and IVUS confirmed good patency without restenosis after intensification of steroid therapy. This case highlights the complexity of ACS secondary to IgG4-related CP. Coronary involvement in IgG4-RD remains under-recognized, necessitating a high index of suspicion and multimodal imaging for diagnosis.</div></div><div><h3>Learning objective</h3><div>Although rare, immunoglobulin G4–related coronary involvement should be considered a potential cause of acute coronary syndrome. Awareness of this entity and a multidisciplinary, multimodality imaging–based approach, including serial coronary computed tomography and intravascular ultrasound to assess treatment response, are essential for optimal management. In cases with insufficient response to corticosteroids, additional immunosuppressive therapy may be required.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 3","pages":"Pages 125-128"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859379","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":"Mechanical thrombectomy and venous-dedicated stent implantation for acute iliofemoral deep vein thrombosis with iliac vein compression","authors":"Ayano Kobayashi,&nbsp;Yasuhiro Tanabe MD, PhD,&nbsp;Kazuki Muramatsu MD,&nbsp;Masahiro Sekiguchi MD,&nbsp;Nozomi Kotoku MD, PhD,&nbsp;Masaki Izumo MD, PhD,&nbsp;Misa Kougo MD,&nbsp;Yoshihiro J. Akashi MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.05.014","DOIUrl":"10.1016/j.jccase.2026.05.014","url":null,"abstract":"<div><div>Venous catheter intervention has been reported to promptly improve symptoms in patients with deep vein thrombosis (DVT) and may potentially prevent progression to post-thrombotic syndrome. However, the dissemination of this treatment in Japan has been limited due to the lack of dedicated devices. In December 2024, venous-specific mechanical thrombectomy and stent systems became available in Japan. We report the case of a 71-year-old man with extensive left iliofemoral DVT complicated by iliac vein compression, which was refractory to direct oral anticoagulants, catheter-directed heparin infusion and balloon angioplasty. He underwent mechanical thrombectomy using the ClotTriever® system (Inari Medical, Irvine, CA, USA), followed by deployment of a Venovo™ venous stent (BD, Franklin Lakes, NJ, USA). Following the intervention, swelling and tightness in the left lower extremity improved immediately. On postoperative day 1, the thigh and calf circumferences had decreased from 50.5 cm and 41.0 cm preoperatively to 46.0 cm and 33.0 cm, respectively. This case suggests that a novel mechanical thrombectomy system, combined with a dedicated venous stent, offers a safe and effective treatment option for refractory iliofemoral DVT without the use of thrombolytic agents.</div></div><div><h3>Learning objective</h3><div>Transcatheter venous intervention using a novel mechanical thrombectomy system combined with dedicated venous stent implantation for extensive deep vein thrombosis with iliac vein compression is effective in restoring venous flow and alleviating symptoms without the use of thrombolytic agents, and may reduce the progression to post-thrombotic syndrome.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 3","pages":"Pages 117-121"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859551","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":"Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy in patients with situs inversus totalis: A two-case series","authors":"Hiroki Ueno MD,&nbsp;Yoshihisa Kanaji MD, PhD,&nbsp;Eisuke Usui MD, PhD,&nbsp;Kaisei Hosokawa MD,&nbsp;Shunta Hiroi MD,&nbsp;Riko Murakami MD,&nbsp;Takahiro Watanabe MD,&nbsp;Kodai Sayama MD,&nbsp;Takumi Watanabe MD,&nbsp;Taishi Yonetsu MD, PhD,&nbsp;Tsunekazu Kakuta MD, PhD","doi":"10.1016/j.jccase.2026.05.013","DOIUrl":"10.1016/j.jccase.2026.05.013","url":null,"abstract":"<div><div>Percutaneous transluminal septal myocardial ablation (PTSMA) is an established treatment for hypertrophic obstructive cardiomyopathy (HOCM), but its application in patients with situs inversus totalis (SIT) is complicated by mirror-image anatomy. We describe two successful PTSMA procedures in women, aged 82 and 69 years, with HOCM and coexisting SIT. The second patient had additional complexities, including Kartagener syndrome and chronic steroid therapy for rheumatoid arthritis. Both patients presented with severe, drug-refractory symptoms and significant left ventricular outflow tract (LVOT) pressure gradients. Guided by meticulous pre-procedural planning and multi-modality imaging, PTSMA was successfully performed, leading to a substantial reduction in LVOT gradients and marked symptomatic relief in both patients. The procedures were well-tolerated without major complications, demonstrating the feasibility of PTSMA despite advanced age, complex comorbidities, and profound anatomical variations. Our experience suggests that PTSMA is a viable, safe, and effective therapeutic option for HOCM in the rare and complex setting of SIT.</div></div><div><h3>Learning objective</h3><div><ul><li><span>1.</span><span><div>To recognize that percutaneous transluminal septal myocardial ablation (PTSMA) can be a feasible, safe, and effective septal reduction therapy for patients with hypertrophic obstructive cardiomyopathy and coexisting situs inversus totalis, leading to significant hemodynamic and clinical improvement.</div></span></li><li><span>2.</span><span><div>To understand that advanced age and comorbidities, such as chronic low-dose steroid use, are not absolute contraindications to PTSMA.</div></span></li><li><span>3.</span><span><div>To appreciate the critical importance of meticulous pre-procedural planning and multi-modality intraprocedural imaging to navigate mirror-image anatomy and ensure procedural success.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 3","pages":"Pages 110-113"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859548","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":"Reply to the comments on A rare case of left ventricular cardiac rupture in the acute phase of takotsubo syndrome","authors":"Shu Iwata MD, PhD,&nbsp;Shoichiro Yatsu MD, PhD,&nbsp;Hirohisa Endo MD, PhD,&nbsp;Manabu Ogita MD, PhD","doi":"10.1016/j.jccase.2026.06.005","DOIUrl":"10.1016/j.jccase.2026.06.005","url":null,"abstract":"","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 3","pages":"Pages 137-138"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859546","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":"Difficulty in identifying the culprit lesion in ST-elevation myocardial infarction with marked coronary tortuosity","authors":"Tetsuo Yamanaka MD,&nbsp;Yuki Tomimitsu MD,&nbsp;Kei Mabuchi MD,&nbsp;Hiroshi Fukunaga MD,&nbsp;Yoshimaro Ichinohe MD,&nbsp;Michiaki Higashitani MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.05.011","DOIUrl":"10.1016/j.jccase.2026.05.011","url":null,"abstract":"<div><div>We report a 90-year-old woman with ST-segment elevation myocardial infarction. Twelve-lead electrocardiography and transthoracic echocardiography suggested a lesion from the anteroseptum to the apex, implicating the left anterior descending artery (LAD). Coronary angiography showed marked tortuosity of the left coronary artery, complicating identification of the occluded LAD. Careful multi-angle evaluation enabled successful reperfusion. This case demonstrates that coronary artery tortuosity (CAT) can hinder culprit lesion identification. Although CAT is associated with myocardial ischemia, its impact on identifying the culprit lesion is rarely reported. Awareness of this scenario is important as tortuosity increases with aging.</div></div><div><h3>Learning objective</h3><div>Coronary artery tortuosity (CAT) can complicate the identification of the culprit lesion in acute myocardial infarction. Careful and systematic interpretation of coronary angiography, in conjunction with electrocardiography and echocardiographic findings, is essential for successful percutaneous coronary intervention in tortuous coronary arteries. With the aging population, the prevalence of CAT is increasing, highlighting the need for heightened clinical awareness and preparedness for complex coronary interventions.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 3","pages":"Pages 129-132"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859550","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":"Progression of chronic thromboembolic pulmonary disease without pulmonary hypertension in a case with JAK2 V617F mutation","authors":"Mizuki Momoi MD, PhD,&nbsp;Atsushi Anzai MD, PhD,&nbsp;Takashi Maeda MD,&nbsp;Shogo Ikegami MD,&nbsp;Yoshiki Shinya MD,&nbsp;Takahiro Hiraide MD, PhD,&nbsp;Yasuyuki Shiraishi MD, PhD,&nbsp;Masaki Ieda MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.06.004","DOIUrl":"10.1016/j.jccase.2026.06.004","url":null,"abstract":"<div><div>Chronic thromboembolic pulmonary disease (CTEPD) is characterized by persistent obstruction of pulmonary arteries with organized thrombotic materials. Patients with CTEPD without pulmonary hypertension (PH) are generally considered unlikely to progress to chronic thromboembolic pulmonary hypertension (CTEPH). Here, we report a case of a 75-year-old woman with essential thrombocythemia harboring <em>JAK2</em> V617F mutation, who had a history of acute pulmonary embolism. Initial evaluation of contrast-enhanced computed tomography and pulmonary angiography revealed organized thrombi predominantly in the right main and lobar pulmonary arteries, accompanied by perfusion defects on lung perfusion scintigraphy. Right heart catheterization (RHC) showed a mean pulmonary arterial pressure (mPAP) of 18 mmHg, leading to a diagnosis of CTEPD without PH. As the patient declined invasive treatment, she was followed with anticoagulation therapy alone. Three years later, her symptoms worsened, and RHC revealed an elevated mPAP of 33 mmHg, along with slight progression of thrombotic lesions and newly identified calcified deposits. She again refused invasive treatment and died one year later despite medical therapy. This case suggests that the <em>JAK2</em> V617F mutation could be a risk factor for progression from CTEPD without PH to CTEPH, underscoring the importance of close follow-up and early consideration of invasive treatment in such patients.</div></div><div><h3>Learning objective</h3><div>This case highlights that chronic thromboembolic pulmonary disease without pulmonary hypertension can progress to chronic thromboembolic pulmonary hypertension, particularly in patients with high-risk features such as the <em>JAK2</em> V617F mutation. It underscores the importance of careful long-term follow-up and early consideration of invasive treatment despite initially normal hemodynamics.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 3","pages":"Pages 133-136"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859380","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}