The treatment of choice is currently surgical repair and long-term follow-up. Neonatal Netw. 4 Concurrently, during the last 15 years TEVAR turned into the preferred modality of physicians dealing with thoracic aorta aneurysms and ATBAD. Coarctation of the aorta (CoA) is a congenital cardiac anomaly with obstruction to blood flow in the descending aorta; it comprises of narrowed aortic segment with localized medial thickening and infolding of the media and superimposed neo-intimal tissue.1,2 Coarctation of the aorta occurs when the aorta is pinched or constricted. Coarctation of the aorta (COA) is a narrowing of the aorta, the major blood vessel that carries blood away from the heart to the body. The treatment of CoA consists of enlarging of the narrowed segment. Traditionally this required open heart surgery. This heart defect causes decreased blood flow to the lower body. save. Neonatology guidelines Newborn Emergency Transport Service WA guidelines {0A9C8654-272A-48DA-8FC7-E26CABFD7BF9} CAHS Medical Library {10975433-2FC8-446A-B2AA-085D5A0E3B6B} Coarctation of the aorta may be missed in newborns because of the low sensitivity (32%) of the neonatal screening examination. The decision was made to perform a hybrid surgical procedure. Curr Cardiol Rep. 2005 Nov;7(6):425-34; Rosenthal E. Coarctation of the aorta from fetus to adult: curable condition or lifelong disease process? Depending on how narrowed the aorta is, coarctation of the aorta can cause mild to extreme … Coarctation of the aorta (Figure 1) accounts for approximately 5% of all congenital heart disease and is found at necropsy in up to 1:1550 patients. It accounts for 6–8% of congenital heart defect cases and ranks as the fifth most common abnormality in this patient group [].Male infants are affected more commonly, and the incidence is likely higher in stillborn infants [].The underlying pathology of aortic coarctation, deceptively, appears simple. Coarctation of the aorta is the most commonly missed congenital heart disease, 3 4 and many cases not diagnosed until adulthood or death are incorrectly attributed to sepsis. During life the size of the aorta increases. In some cases, coarctation presents as … The type of coarctation is defined by its location in relation to the ductus arteriosus. Last published: 2004. Coarctation of the aorta may occur as an isolated defect or in association with various other lesions, most commonly bicuspid aortic valve and ventricular septal defect (VSD). Coarctation of the aorta therefore describes the narrowing of the aorta. The term, congenital stenosis of the isthmus, is also employed. Surgery has remained as the gold standard in neonates but catheter intervention has usurped it in children, adolescents, and adults. This constriction (or narrowing) is usually only in one location and occurs between the upper and lower half of the body. Treatment depends on a child's age and the size, location, and severity of the VSD. Neonates may present in shock and require prostaglandin E 1 to maintain ductal patentcy until the time of surgical repair. Balloon angioplasty and stenting may be carried out as a first treatment (in 'native' coarctation) or if previous surgical or angioplastic … Coarctation of the aorta: Surgical or percutaneous treatment. Coarctation of the aorta is mostly existing at birth. When this occurs, your heart must pump harder to force blood through it. Congenital heart disease Aortic coarctation Bicuspid aortic valve Cardiac surgery Stent Aneurysm Aorta Treatment outcome KEY POINTS Coarctation of the aorta is defined by a discrete narrowing of the aorta. Coarctation of the aorta therefore describes the narrowing of the aorta. The great advantage of the Bentley graft stents is the possibility of simultaneous treatment of the aortic coarctation and persistent arterial duct (if present). This means that the left ventricle has to work much harder than normal to push the blood through the narrowed blood vessel. x Transcatheter mitral valve (MV) repair with MitraClip (Abbott Vascular, Santa Clara, California) is an established treatment in patients with severe mitral regurgitation (MR) at inoperable or high surgical risk. HANSON J, IKKOS D, JOHANSSON L, RUDHE U, SENNING A. Coarctation of the abdominal aorta: case report and description of succesful surgical treatment. Circulation, 131, e363-e365. This means that the left ventricle has to work much harder than normal to push the blood through the narrowed blood vessel. This is a topic you will see on your pediatric nursing lecture exams and possibly the NCLEX exam. Treatment Older children with significant coarctation of the aorta should be treated relatively soon after diagnosis. Reference Guntheroth 1 – Reference Canniffe, Ou and Walsh 6 Even after early repair of coarctation of the aorta, arterial hypertension is common, with prevalence between 25 and 68%, depending on the definition of hypertension and the population studied. This procedure is associated with complications such as the development of adverse flow conditions. Online Medical Dictionary and glossary with medical definitions, c listing. Coarctation of the aorta repair: Coarctation of the aorta occurs when a part of the aorta has a very narrow section. In coarctation of the aorta, a narrowing forms along the vessel that constricts (limits) blood flow. British Heart Journal 1970;32:633-640. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) For this reason, coarctation of the aorta is often considered a critical congenital heart defect. In severe cases, there can be reduced blood flow to the body. Aortic coarctation is a common congenital heart disease. Following treatment for coarctation of the aorta, the late complications include recurrence of the coarctation (narrowed again), aneurysm (ballooning of the vessel), or pseudoaneurysm (a contained leak within the aorta wall).After surgical treatment, the risk of recurrence is between 5 and 10 percent. A balloon is then inflated within the narrowing. A stent (a small tube) may be placed within the narrowing to keep it dilated. narrowing) in the aorta. If the aortic coarctation is severe, it's usually diagnosed during infancy. It can occur alone but it frequently shows up in combination with other heart defects. Young patients who receive stents to treat coarctation of the aorta see good hemodynamic results over the long term, combined data from the COAST and COAST II trials show, but late follow-up from these two studies also suggests that their complication risk doesn’t remain static—stent fractures, reinterventions, and aortic aneurysms can arise 4 to 5 years after treatment. Reference Padua, Garcia and Rubira 1 It is defined as a short-segment narrowing in the area of the aortic isthmus. • Coarctation of aorta • Thyroid/parathyroid disease Assess for Identifiable Causes of Hypertension TREATMENT Lifestyle Modifications Not at Goal Blood Pressure (<140/90 mmHg) (<130/80 mmHg for patients with diabetes or chronic kidney disease) See Strategies for Improving Adherence to Therapy Initial Drug Choices Without Compelling Indications Coarctation of the aorta is one of the best-known congenital cardiac conditions and describes a narrowing of part of the thoracic aorta, most commonly of the isthmus around the insertion of the arterial duct. They may often appear healthy until a doctor detect… [1-3] Diagnosis is most often made during infancy and childhood, and only rarely in adulthood. Forbes T, Matisoff D, Dysart J, Aggarwal S. Treatment of coexistent coarctation and aneurysm of the aorta with covered stent in a pediatric patient. While overall morbidity and mortality rates are low for patients undergoing intervention for coarctation, both surgical and transcatheter interventions are not free from adverse outcomes. Coarctation of the aorta is a common cause of secondary hypertension in children, especially males, but may not be detected until adulthood because it … Circulation 1989;80(4):840–845. While doctors do not know what causes multiple heart defects to form together, coarctation of the aorta often occurs along with other congenital heart defects. However, the constriction may be proximal to the left subclavian artery or rarely in the abdominal aorta. We report a case of a patient with aortic stenosis (AS) and coarctation of the aorta (CoA). Peak pull back gradient of > 20 mmhg across coarctation site on angiography. Prevention. This narrowing means that less oxygen-rich blood is sent to the body. The coarctation of the aorta (CoA), a local narrowing of the aortic arch, accounts for 7 % of all congenital heart defects. Introduction. Coarctation of the aorta is generally present at birth (congenital). Although such measures aid in controlling hypertension due to aortic coarctation, the definitive treatment of coarctation of aorta often involves surgical intervention (98, 99). There are two suggested theories as to how this happens: 1. Coarctation of the aorta is a birth defect in which a part of the aorta is narrower than usual. Cardiovascular specialists generally agree that percutaneous angioplasty, with stent or stent‐graft implantation, is the preferred nonsurgical management option for both congenital and recurrent aortic coarctation. Coarctation of the aorta. The oxygen is transferred via the placenta to the … Coarctation of the aorta signifies a constriction of the aorta in the region of its juncture with the ductus arteriosus or its vestige. Not all birth defects can be prevented. In this review you will learn about the congenital heart defect known as coarctation of the aorta (TGA). arteriopathy, balloon angioplasty, coarctation of the aorta, pharmacological treatment, stenting, surgical treatment. 1. 2009 2. Coarctation of the aorta is a heart defect that is present at birth (congenital). The treatment your child needs will depend on the severity of the coarctation. 2009 Mar-Apr;28(2):103-13; Rao PS. Additionally, transcatheter balloon angioplasty and endovascular stent placement offer less invasive approaches for the treatment of coarctation of the aorta for some patients. , Treatment. Coarctations are most common in the aortic arch.The arch may be small in babies with coarctations. Sometimes the coarctation is minor and might not even cause symptoms. share. Hybrid surgery is becoming more popular in the treatment of children with congenital heart disease, particularly small infants and neonates. ESC Clinical Practice Guidelines. Objectives . Over time, it can lead to problems such as extremely high blood pressure. Coarctation of the aorta consists of localized narrowing of the aortic arch just distal to the origin of the left subclavian artery. The study was performed in accordance with the local eth-ics committee guidelines, University Hospitals Leuven, Belgium (S61175). Cases are often found incidentally. 2005 … Raumschiff Enterprise – Das nächste Jahrhundert ist eine US-amerikanische Science-Fiction-Fernsehserie, die in den Vereinigten Staaten von 1987 bis 1994 unter dem Originaltitel Star Trek: The Next Generation erstausgestrahlt wurde. Coarctation of the aorta is a type of congenital heart defect (present at birth) in which the aorta is narrowed. Coarctation of the aorta (also called aortic coarctation) forces your baby’s heart to pump harder in order to push blood through the constricted part of the aorta. The choice of treatment depends on the age of the patient, the anatomy of the area of obstruction, and other factors. Congenital heart disease Aortic coarctation Bicuspid aortic valve Cardiac surgery Stent Aneurysm Aorta Treatment outcome KEY POINTS Coarctation of the aorta is defined by a discrete narrowing of the aorta. Aortic coarctation is a congenital stenosis or occlusion of the aorta, usually located in the region of the ligamentum arteriosum. Following treatment for coarctation of the aorta, the late complications include recurrence of the coarctation (narrowed again), aneurysm (ballooning of the vessel), or pseudoaneurysm (a contained leak within the aorta wall).After surgical treatment, the risk of recurrence is between 5 and 10 percent. rrowing of the aorta (aortic coarctation, pronounced ko-ahrk-TAY-shun) forces your heart to pump harder to move blood through the aorta. If region of the aorta is narrowed, it is difficult for blood to give through the artery. Nursing Diagnosis and Interventions for Coarctation of the Aorta (CoA) 1. If left untreated, this condition can lead to severe hypertension , heart failure , stroke , … AGEING. If the stenosis is severe, collateral circulation develops around the coarctation site through the intercostal arteries and the branches of the subclavian arteries; a lower transcoarctation gradient can result by enabling blood flow to bypass the obstruction They should be essential in everyday clinical decision making. Am Heart J. A child with a small defect that causes no symptoms may only need to visit a cardiologist regularly to make sure that there are no other problems. If the narrowing is severe enough and if it is not diagnosed, the baby may have serious problems and may need surgery or other procedures soon after birth. Workup: ECG, Chest Xray, Echo. * Long Cases in Clinical Medicine, ABM Abdullah Page: 255. The care of a patient with CoA depends upon the severity of the CoA, patient age, and clinical presentation. Late presentation of coarctation of the aorta. Stenting is a recommended therapy to reduce the pressure gradient. 1956 Aug; 52 (2):314–320. How is coarctation of the aorta treated? A computer-aided treatment planning based on flow simulations can help to predict possible … Agarwala BN, Bacha E. Clinical manifestations and diagnosis of coarctation of the aorta. As endovascular procedures developed, ballooning and stenting of narrowed segment emerged as treatment of choice. From its dramatic appearance as a part of Hypo plastic Left Heart Syndrome(HLHS), to early Congestive Heart Failure(CHF)in neonatal and early infantile age, to undetected Hypertension (HTN) in early or even late adulthood. Treatment of hypertension. If left untreated, this condition can lead to severe hypertension , heart failure , stroke , coronary artery disease or aortic … There is growing evidence that many patients with bicuspid aortic valve (BAV) or aortic coarctation have disorders of vascular connective tissue as well, involving loss of elastic tissue. Young patients who receive stents to treat coarctation of the aorta see good hemodynamic results over the long term, combined data from the COAST and COAST II trials show, but late follow-up from these two studies also suggests that their complication risk doesn’t remain static—stent fractures, reinterventions, and aortic aneurysms can arise 4 to 5 years after treatment. The aorta carries blood from the eye to the vessels that provide the system with blood and nutrients. While acquired cases have been reported, most cases are congenital and occur in about 4 of 10 000 live births. A newer way of treating coarctation of the aorta is by using balloon angioplasty. This narrower portion of the aorta can occur anywhere, but most often it is found just past the arch, in the descending aorta. References. Management of hypertensive condition in 2020 according to AHA/ASA guidelines. 1. Indications for surgical or endovascular repair are based on aneurysm location and risk factors for rupture such as aneurysm size, rate of growth, and associated conditions, while medical management … ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on Aortic Diseases. Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The aorta is the main artery carrying red (oxygenated) blood from the heart to the body. Coarctation of the aorta is a congenital heart disease that significantly reduces life expectancy1,2 and is associated with increased morbidity even years after successful repair.3,4 With an incidence of 3 to 4 cases per 10 000 live births,5,6 aortic coarctation accounts for 5% to 8% of all congenital heart defects and is frequently associated with other congenital heart disease such as bicuspid aortic valve disease.7 About one in every 33 babies is born with a birth defect. The word coarctation means "pressing or drawing together; narrowing". 5 Coarctation of aorta is twice more common in male than female. In coarctation of the aorta, a narrowing forms along the vessel that constricts (limits) blood flow. Published by: National Institute for Health and Care Excellence. The aorta is the large artery that carries oxygen-rich blood from the left ventricle to the body. Coarctation of the aorta is a narrowing of the aorta between the upper body branches and the lower body branches. Campbell M. Natural history of coarctation of the aorta. The shape looks like an hourglass timer. There are many different variations of aortic arch anomalies. Both procedures provide successful relief of the obstruction for most patients at low risk. Coarctation means a narrowing in the blood vessel wall. Coarctation is a narrowing or pinching in the aorta, usually between the aortic arch and descending aorta. Coarctation of the aorta is typically a stenosis of the descending aorta in the area of the ductus arteriosus Botalli and caused by ductal tissue in the aortic wall. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases external link opens in a new window. Coarctation of the aorta (CoA) accounts for 5% to 7% of congenital heart disease, with an incidence of 0.3 to 0.4 per 1000 live births. Coarctation of the aorta is a congenital heart disease that is associated with an increased morbidity and mortality even years after treatment. Percutaneous catheter interventions, including balloon dilatation and stenting, are frequently performed to treat the coarcted segment of the aorta. Despite early detection and both catheter-based and surgical interventions patients who have undergone aortic coarctation repair continue to have a reduced life expectancy. 9. Abstract Coarctation of the aorta is a common form of congenital heart disease. This narrowing of artery apply pressure to the heart to forcefully pump the blood. Coarctation of the aorta; Cardiology Patient Pages. 1959; Suppl 245:315–322. Acta Chir Scand Suppl. Obrien, P., & Marshall, A. C. (2015). Cohen M. et al. Coarctation of the aorta. The manuscript will discuss the epidemiology and etiology of the adult with coarctation of the aorta (CoA) as well as describe the embryology, anatomy, pathophysiology, and clinical presentation in order to recognize and appropriately diagnose an adult patient with CoA. 4,8 This additional physical assessment will help detect significant aortic coarctation by assessing timing and amplitude of both pulses in … Transthoracic echocardiography (TTE) has the advantages of portability, accessibil-ity, and low cost. When this occurs, your heart must pump harder to force blood through it. The cause coarctation of aorta is unknown and it usually begins before birth and rarely develops late in life. Coarctation of the aorta (CoA or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. OR. In most kids, a small defect will close on its own without surgery. 1. Pediatr Cardiol . Presentation, evaluation, and treatment of coarctation of the aorta is different in neonates and infants compared with older children. This complete version of the updated guidelines for hypertension is written for the health care professional who wants to understand the science behind the new recommendations on high blood pressure. J Am Coll Cardiol 2011;58:2664-74. The aorta is the main artery carrying red (oxygenated) blood from the heart to the body. While acquired cases have been reported, most cases are congenital and occur in about 4 of 10 000 live births. Forbes TJ, Kim DW, Du W. Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC. The aorta arises from the left ventricle and carries oxygenated blood from the heart to the body. Preoperative hypertension can be effectively treated using beta-blockers. The narrowing makes it difficult for blood to get through to the lower extremities. The goal should be to reduce upper extremity hypertension, but remember that vigorous attempts to achieve normal upper extremity blood pressure (BP) may result in inadequate lower-body perfusion. 10 The aortic expansion rate is higher in patients with BAV than in patients with tricuspid aortic valve: 0.19 versus 0.13 cm/y. In mild cases, your child may only require regular supervision in an outpatient clinic. Aneurysm of the thoracic aorta is less common than in the abdominal aorta, but it is clinically important because of the risk of rupture and death. Preventive treatment of as yet unruptured brain AVMs has been controversial, as several studies suggested favorable long-term outcome for unruptured AVM patients not undergoing intervention. [1-3] Diagnosis is most often made during infancy and childhood, and only rarely in adulthood. Coarctation of the aorta: Long-term follow-up and prediction of outcome after surgical correction. This condition accounts for 7% to 10% of all congenital heart lesions, 1 and the presentation varies. Adults and older children who are diagnosed with coarctation of the aorta may have milder cases and not have symptoms. References. Endocrinological shock Children who have either recently completed a prolonged course of steroid therapy or are on chronic steroid replacement therapy are at high risk for endocrinological shock. As a result, the left-hand side of the heart has to work harder to pump blood away from the heart to the rest of the body. Coarctations are most common in the aortic arch.The arch may be small in babies with coarctations. Case: a 1-month-old baby presented with severe AS and CoA. Coarctation of the aorta accounts for 5–7% of all CHDs, and has an incidence of 0.3–0.4% per 1000 live births. Coarctation of the aorta is a type of congenital heart defect (present at birth) in which the aorta is narrowed. Coarctation of the aorta (COA) is a heart defect that is present at birth (congenital). 2018 AHA/ACC guideline for the management of adults with congenital heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. This narrowing causes the left side of the heart to work harder to pump blood through the aorta. Mayo Clinic; 2020. But a woman can take steps to increase her own chance of having a … Information. Decreased cardiac output related to cardiac malformations. 29-year-old female presents to the emergency department with sudden onset severe chest pain. Surgery was the only choice of therapy for CoA until 1982 when balloon angioplasty became an available alternative for its treatment. diography guidelines. Aortic coarctation (AC) is characterized by localized narrowing of the thoracic aorta. Ringel RE, Vincent J, Jenkins KJ, et al. What causes coarctation of the aorta? The Coarctation of the aorta (CoA) is a discrete narrowing of the thoracic aorta just distal to the left subclavian artery (image 1). Heart. Coarctation of the aorta originates usually from a defect in the vessel media during development of the left fourth and sixth aortic arches. Treatment with oral hypotensive agents is indicated if BP is above the 99th centile for age, ... 2016 European Society of Hypertension Guidelines for the management of high blood pressure in children and adolescents. Coarctation of the aorta (CoA) is a relatively common defect that accounts for 5-8% of all congenital heart defects. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta … Assess the degree of cyanosis (circumoral, mucous membranes, clubbing). [Google Scholar] INMON TW, POLLOCK BE. It means the aorta is narrower than it should be. Coarctation of the aorta (CoA or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. descending aorta diameter [26]. blood. Following treatment for coarctation of the aorta, the late complications include recurrence of the coarctation (narrowed again), aneurysm (ballooning of the vessel), or pseudoaneurysm (a contained leak within the aorta wall).After surgical treatment, the risk of recurrence is between 5 and 10 percent. At least yearly follow-up for patients who have had surgical repair of coarctation at the aorta or percutaneous intervention for aortic coarctation (level of evidence: C) Late postoperative thoracic aortic imaging to assess for aortic dilatation or aneurysm formation, even if the coarctation repair appears to be satisfactory (level of evidence: B) Aortic coarctation (AC) is characterized by localized narrowing of the thoracic aorta. The normal expansion rate is about 1–2 mm/year. Coarctation of the aorta (CoA) is typically a discrete narrowing of the thoracic aorta just distal to the left subclavian artery. Wij willen hier een beschrijving geven, maar de site die u nu bekijkt staat dit niet toe. Additionally, children with some congenital cardiovascular malformations, such as coarctation of the aorta or severe aortic valve stenosis, can also develop obstructive shock. An enlarged aorta can occur in people with Marfan syndrome, Turner syndrome, coarctation of the aorta, or a bicuspid aortic valve. Coarctation of aorta is a condition in whi ch there is narrowing of aorta which is a major blood vessel of the body. Clinical data, including age, sex, type and location of the coarctation and pre-vious interventions were recorded at inclusion. 3. Double outlet right ventricle (DORV) is a heart disease that is present from birth (congenital).The aorta connects to the right ventricle (RV, the chamber of the heart that pumps oxygen-poor blood to the lungs), instead of to the left ventricle (LV, the chamber that normally pumps oxygen-rich blood to the body). For fetuses at high risk for developing coarctation, a novel experimental treatment approach is being investigated, wherein the mother inhales 45% oxygen three times a day (3 x 3–4 hours) beyond 34 weeks of gestation. Coarctation means a narrowing in the blood vessel wall. Aortic coarctation accounts for 5–10% of all congenital heart disease (CHD). The operator should interro-gate the aortic root and ascending aorta in the parasternal long-axis views, parts of the arch and descending thoracic aorta in the supra-sternal view, and a segment of the abdominal Coarctation of the aorta is a relatively common condition that represents 5–10% of all structural congenital heart abnormalities. A balloon catheter (a thin, flexible, hollow tube with a deflated balloon at the tip) is inserted into a large blood vessel, usually an artery in the groin. Coarctation of the aorta is a congenital heart defect (present when your child was born). Transcatheter systolic coarctation gradient 20 mm Hg is an indication for intervention with treat- The authors have no conflict of interest to declare. Aortic coarctation may reoccur even after successful surgical repair or balloon dilation done in infancy or adulthood. Coarctation of Aorta - Treatments The coarctation narrowing can be repaired by surgery or non-surgical balloon dilation. It is 7% of all congenital heart diseases. Coarctation of aorta. Pathophysiology. This may be used in older children and adults who have been diagnosed with the condition. The guidelines recommend that every patient with systemic arterial hypertension have the brachial and femoral pulses palpated simultaneously. Transcatheter systolic coarctation gradient … It accounts for 6–8% of a ll congenital heart diseases. Read on to learn details about the condition. Coarctation of the aorta is a narrowing of the aorta that can be successfully treated with surgery or catheterization techniques. It's typically in an isolated location just after the "arch" of the aorta. The JNC 7 Complete Report focuses on the new evidence, including a revised treatment algorithm, drug tables, and more. Coarctation of the aorta means that a part of the aorta is narrowed, which causes the left ventricle to work harder.
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