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Article ; Online: Clinical Outcomes and Echocardiographic Predictors of Reintervention After Interrupted Aortic Arch Repair.

McMullen, Hannah L / Harrington, Jamie K / Blitzer, David / Pasumarti, Nikhil / Levasseur, Stéphanie / Bacha, Emile / Kalfa, David

Pediatric cardiology

2024 Volume 45, Issue 5, Page(s) 967–975

Abstract: Left ventricular outflow tract obstruction (LVOTO) remains a significant complication after primary repair of interrupted aortic arch with ventricular septal defect (IAA-VSD). Clinical and echocardiographic predictors for LVOTO reoperation are ... ...

Abstract	Left ventricular outflow tract obstruction (LVOTO) remains a significant complication after primary repair of interrupted aortic arch with ventricular septal defect (IAA-VSD). Clinical and echocardiographic predictors for LVOTO reoperation are controversial and procedures to prophylactically prevent future LVOTO are not reliable. However, it is important to identify the patients at risk for future LVOTO intervention after repair of IAA-VSD. Patients who underwent single-stage IAA-VSD repair at our center 2006-2021 were retrospectively reviewed, excluding patients with associated cardiac lesions. Two-dimensional measurements, LVOT gradients, and 4-chamber (4C) and short-axis (SAXM) strain were obtained from preoperative and predischarge echocardiograms. Univariate risk analysis for LVOTO reoperation was performed using unpaired t-test. Thirty patients were included with 21 (70%) IAA subtype B and mean weight at surgery 3.0 kg. Repair included aortic arch patch augmentation in 20 patients and subaortic obstruction intervention in three patients. Seven (23%) required reoperations for LVOTO. Patient characteristics were similar between patients who required LVOT reoperation and those who did not. Patch augmentation was not associated with LVOTO reintervention. Patients requiring reintervention had significantly smaller LVOT AP diameter preoperatively and at discharge, and higher LVOT velocity, smaller AV annular diameter, and ascending aortic diameter at discharge. There was an association between LVOT-indexed cross-sectional area (CSAcm
MeSH term(s)	Humans ; Female ; Retrospective Studies ; Male ; Reoperation ; Aorta, Thoracic/surgery ; Aorta, Thoracic/diagnostic imaging ; Echocardiography ; Ventricular Outflow Obstruction/surgery ; Ventricular Outflow Obstruction/diagnostic imaging ; Heart Septal Defects, Ventricular/surgery ; Heart Septal Defects, Ventricular/diagnostic imaging ; Infant ; Postoperative Complications ; Infant, Newborn ; Treatment Outcome ; Cardiac Surgical Procedures/methods
Language	English
Publishing date	2024-03-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	800857-7
ISSN	1432-1971 ; 0172-0643
ISSN (online)	1432-1971
ISSN	0172-0643
DOI	10.1007/s00246-024-03419-7
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Zs.A 1528: Show issues

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Article ; Online: Outcomes after neonatal cardiac surgery: The impact of a dedicated neonatal cardiac program.

Goldshtrom, Nimrod / Vasquez, Angelica M / Chaves, Diana Vargas / Bateman, David A / Kalfa, David / Levasseur, Stéphanie / Torres, Alejandro J / Bacha, Emile / Krishnamurthy, Ganga

The Journal of thoracic and cardiovascular surgery

2022 Volume 165, Issue 6, Page(s) 2204–2211.e4

Abstract: Objectives: Prematurity is a risk factor for in-hospital mortality after cardiac surgery. The structure of intensive care unit models designed to deliver optimal care to neonates including those born preterm with critical congenital heart disease is ... ...

Abstract	Objectives: Prematurity is a risk factor for in-hospital mortality after cardiac surgery. The structure of intensive care unit models designed to deliver optimal care to neonates including those born preterm with critical congenital heart disease is unknown. The objective of this study was to evaluate in-hospital outcomes after cardiac surgery across gestational ages in an institution with a dedicated neonatal cardiac program. Methods: This study is a single-center, retrospective review of infants who underwent cardiac surgical interventions from our dedicated neonatal cardiac intensive care program between 2006 and 2017. We evaluated in-hospital mortality and morbidity rates across all gestational ages. Results: A total of 1238 subjects met inclusion criteria over a 11-year period. Overall in-hospital mortality after cardiac surgery was 6.1%. The mortality rate in very preterm infants (n = 68; <34 weeks' gestation at birth) was 17.6% (odds ratio, 3.52 [1.4-8.53]), versus 4.3% in full-term (n = 563; 39-40 weeks) referent/control infants. Very preterm infants with isolated congenital heart disease (without evidence of other affected organ systems) experienced a mortality rate of 10.5% after cardiac surgery. Neither the late preterm (34-36 Conclusions: In this study of a single center with a dedicated neonatal cardiac program, we report some of the lowest mortality and morbidity rates after cardiac surgery in preterm infants in the recent era. The potential survival advantage of this model is most striking for very preterm infants born with isolated congenital heart disease.
MeSH term(s)	Infant ; Female ; Infant, Newborn ; Humans ; Infant, Premature ; Infant, Premature, Diseases ; Gestational Age ; Cardiac Surgical Procedures/adverse effects ; Heart Defects, Congenital/surgery
Language	English
Publishing date	2022-06-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2022.06.013
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Article ; Online: Infection prevention and control and related practices in African neonatal units: The Pan-African neonatal care assessment study (PANCAS).

Frantzis, Irene / Levasseur, Stéphanie / Huebner, Jack / Mahida, Maitry / Larussa, Philip / James, Wilmot / Abebe, Workeabeba / Ngwenya, Crispen / Mupere, Ezekiel / Rosenthal, Susan L / Patterson, Janna / Johnson, Julia / Strehlau, Renate / Lulseged, Sileshi / Stanberry, Lawrence R / Saiman, Lisa

International journal of hygiene and environmental health

2024 Volume 259, Page(s) 114357

Abstract: Background: The burden of neonatal mortality is primarily borne by low- and middle-income countries (LMICs), including deaths due to healthcare-associated infections (HAIs). Few studies have assessed infection prevention and control (IP&C) practices in ... ...

Abstract	Background: The burden of neonatal mortality is primarily borne by low- and middle-income countries (LMICs), including deaths due to healthcare-associated infections (HAIs). Few studies have assessed infection prevention and control (IP&C) practices in African units caring for small and/or sick newborns aimed to reduce HAIs. Methods: We performed a mixed-methods study composed of a survey and virtual tour to assess IP&C and related practices. We created a survey composed of multiple-choice and open-ended questions delivered to site respondents via Zoom or video equivalent. Respondents provided a virtual tour of their unit via video and the study team used a checklist to evaluate specific practices. Results: We recruited 45 units caring for small and sick newborns in 20 African countries. Opportunities to optimize hand hygiene, Water, Sanitation and Hygiene (WASH) practices, Kangaroo Mother Care, and IP&C training were noted. The virtual tour offered further understanding of IP&C challenges unique to individual sites. All respondents expressed the need for additional space, equipment, supplies, education, and IP&C staff and emphasized that attention to maternal comfort was important to IP&C success. Discussion: This study identified opportunities to improve IP&C practices using low-cost measures including further education and peer support through learning collaboratives. Virtual tours can be used to provide site-specific assessment and feedback from peers, IP&C specialists and environmental engineering experts.
Language	English
Publishing date	2024-04-01
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2009176-X
ISSN	1618-131X ; 1438-4639
ISSN (online)	1618-131X
ISSN	1438-4639
DOI	10.1016/j.ijheh.2024.114357
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Article ; Online: 3D-Printed Cardiac Models for Fetal Counseling: A Pilot Study and Novel Approach to Improve Communication.

Marella, Nicole Toscana / Gil, Adriana Montes / Fan, Weijia / Aristizabal, Chantal Angueyra / Asrani, Priyanka / Harrington, Jamie K / Channing, Alexandra / Setton, Matan / Shah, Amee M / Levasseur, Stéphanie / Glickstein, Julie / Farooqi, Kanwal M

Pediatric cardiology

2023 Volume 44, Issue 8, Page(s) 1800–1807

Abstract: A fetal cardiology consultation involves using two-dimensional drawings to explain the cardiac anatomy which can result in inherent variation in how the congenital heart disease (CHD) is conveyed. In this pilot study, we incorporated three-dimensional ... ...

Abstract	A fetal cardiology consultation involves using two-dimensional drawings to explain the cardiac anatomy which can result in inherent variation in how the congenital heart disease (CHD) is conveyed. In this pilot study, we incorporated three-dimensional printed (3DP) models into fetal counseling to demonstrate feasibility and evaluate the impact on parental knowledge, understanding, and anxiety. Parents with a prenatal diagnosis of a muscular ventricular septal defect (VSD) and/or coarctation of aorta were enrolled. Providers were randomized into a Model or Drawing Group and crossed after six months. Parents completed a survey after the consultation which evaluated knowledge of the CHD lesion, expectant surgical management, self-rated understanding, attitude towards the visualization tool, and anxiety. Twenty-nine patients enrolled over a 12 month period. Twelve consultations were done for coarctation of aorta, 13 for VSD, and four for coarctation with a VSD. Both Model and Drawing groups scored similarly in self-reported understanding and confidence, helpfulness of and improvement in communication with the visualization tool. The Model group had higher scores on questions related to the CHD anatomy and surgical intervention [5 [4-5] versus 4 [3.5-5]], p = 0.23 although this didn't reach statistical significance. For the majority (83%) of consultations, the cardiologist agreed that the 3D model improved communication. In this pilot study, we demonstrate the use of 3DP cardiac models during prenatal CHD counseling is feasible and produces results related to parental understanding and knowledge that are equal to and possibly better than the current standard of care.
MeSH term(s)	Female ; Humans ; Pregnancy ; Aortic Coarctation/diagnostic imaging ; Aortic Coarctation/surgery ; Communication ; Counseling ; Heart Defects, Congenital/diagnostic imaging ; Heart Defects, Congenital/surgery ; Models, Anatomic ; Pilot Projects ; Printing, Three-Dimensional
Language	English
Publishing date	2023-05-18
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	800857-7
ISSN	1432-1971 ; 0172-0643
ISSN (online)	1432-1971
ISSN	0172-0643
DOI	10.1007/s00246-023-03177-y
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Article ; Online: The role of fetal echocardiogram after detection of extracardiac anomalies in utero (fetal echocardiogram for extracardiac malformations).

Barris, David M / Brailovschi, Yaniv / Shah, Amee / Levasseur, Stéphanie / Nhan-Chang, Chia-Ling / Miller, Russell / Simpson, Lynn / Freud, Lindsay R

Prenatal diagnosis

2021 Volume 41, Issue 9, Page(s) 1134–1139

Abstract: Objective: We aimed to investigate the utility of comprehensive screening fetal echocardiography (FE) for patients diagnosed with any type of fetal extracardiac malformation (ECM) at a single multidisciplinary fetal center.: Methods: We ... ...

Abstract	Objective: We aimed to investigate the utility of comprehensive screening fetal echocardiography (FE) for patients diagnosed with any type of fetal extracardiac malformation (ECM) at a single multidisciplinary fetal center. Methods: We retrospectively reviewed all patients presenting to our referral center for FE due to a prenatal diagnosis of ECM (January 2013-December 2018). Results: Among 641 patients with ≥1 ECM referred for FE, 78 (12.2%) had CHD diagnosed at 25.6 ± 0.5 weeks. The frequency of CHD by type of ECM ranged from 35.1% for craniofacial to 9.8% for thoracic. Increasing number of fetal ECMs was strongly associated with CHD: odds ratio 2.01 (95% confidence interval: 1.06-3.69) for two ECMs, 9.57 (2.00-49.05) for three ECMs, and 11.68 (3.84-37.15) for more than three ECMs. Of fetuses with ECM and an abnormal genetic finding, 33.3% had CHD as compared to 10.9% of those without (p < 0.0001). Obstetric anatomy sonogram detected 43.6% of CHD. Conclusion: CHD was commonly diagnosed among fetuses with any type of ECM at our center but was not always detected on obstetric sonogram. As the presence of CHD may impact decision-making and perinatal care, patients with a diagnosis of any fetal ECM should be considered for FE.
MeSH term(s)	Adult ; Congenital Abnormalities/diagnosis ; Congenital Abnormalities/diagnostic imaging ; Echocardiography/methods ; Echocardiography/trends ; Female ; Fetus/diagnostic imaging ; Gestational Age ; Humans ; Noninvasive Prenatal Testing/instrumentation ; Noninvasive Prenatal Testing/methods ; Noninvasive Prenatal Testing/trends ; Pregnancy ; Retrospective Studies
Language	English
Publishing date	2021-07-22
Publishing country	England
Document type	Journal Article
ZDB-ID	82031-3
ISSN	1097-0223 ; 0197-3851
ISSN (online)	1097-0223
ISSN	0197-3851
DOI	10.1002/pd.6012
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Article ; Online: Outcomes of Surgical Repair of Complex D-Transposition of the Great Arteries.

Olds, Anna / Nakamura, Yuki / Levasseur, Stephanie / Shah, Amee / Freud, Lindsay / Chelliah, Anjali / Chai, Paul / Quaegebeur, Jan / Bacha, Emile / Kalfa, David

World journal for pediatric & congenital heart surgery

2018 Volume 9, Issue 6, Page(s) 605–612

Abstract: Background: D-transposition of the great arteries (TGA) or TGA-type double outlet right ventricle (DORV) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) may be treated with the arterial switch operation (ASO), ...

Abstract	Background: D-transposition of the great arteries (TGA) or TGA-type double outlet right ventricle (DORV) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) may be treated with the arterial switch operation (ASO), Rastelli, Réparation à l'Etage Ventriculaire (REV), or Nikaidoh procedures. We evaluated midterm results of these techniques. Methods: We retrospectively reviewed 42 cases of anatomic repair from 2005 to 2014 at our institution for TGA (n = 29) or TGA-type DORV (n = 13) with VSD and LVOTO. We analyzed outcomes (mortality, reoperation, residual/recurrent LVOT peak gradient ≥20 mm Hg, right ventricular outflow tract [RVOT] peak gradient ≥40 mm Hg) and performed a risk analysis. Mean follow-up was 5.77 ± 3.08 years. Results: Seventeen (40.5%) patients had an ASO with (n = 4) or without (n = 13) LVOTO resection. The Rastelli, REV, and Nikaidoh procedures were used in 14 (33%), 5 (12%), and 6 (14%) patients, respectively. There were no mortalities or moderate aortic insufficiency at last follow-up. Three (9%) patients developed LVOT gradient ≥20 mm Hg, while nine (21.4%) patients had RVOT obstruction. Reoperations included RVOT/pulmonary artery reoperation (n = 10; 23.8%) and LVOT reoperation (n = 1; 2.5%). Freedom from reoperation was 84% ± 6% and 75% ± 9% at one and three years, respectively, for the entire cohort with no differences between groups by type of operation (log-rank P = .64). The Nikaidoh procedure compared favorably to all other techniques in terms of reoperation (n = 0/6; 0% vs n = 13/36; 36%; P = .08). Conclusions: Midterm outcomes after anatomic repair for TGA or TGA-type DORV with LVOTO and VSD are excellent but vary by surgical technique. The Nikaidoh procedure seems to compare favorably to the other techniques.
MeSH term(s)	Arterial Switch Operation/methods ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Retrospective Studies ; Second-Look Surgery/methods ; Transposition of Great Vessels/surgery
Language	English
Publishing date	2018-10-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2550261-X
ISSN	2150-136X ; 2150-1351
ISSN (online)	2150-136X
ISSN	2150-1351
DOI	10.1177/2150135118789384
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Article: Performing an urgent neonatal cardiac intervention safely during the COVID-19 pandemic.

Spencer, Robert / Chaves, Diana Vargas / Brooks, Maria Cristina / Goldshtrom, Nimrod / Moroz, Leslie / Miller, Russel / Glickstein, Julie / Levasseur, Stéphanie / Bacha, Emile A / Turner, Mariel E / Farooqi, Kanwal M

Progress in pediatric cardiology

2020 Volume 60, Page(s) 101265

Abstract: The current pandemic has driven the medical community to adapt quickly to unprecedented challenges. Among these challenges is the need to minimize staff exposure to COVID-19 during neonatal cardiac procedures. In this report, we describe measures we have ...

Abstract	The current pandemic has driven the medical community to adapt quickly to unprecedented challenges. Among these challenges is the need to minimize staff exposure to COVID-19 during neonatal cardiac procedures. In this report, we describe measures we have taken to protect health care workers while ensuring successful outcomes. These measures include wearing appropriate personal protective equipment, physical distancing, designating separate delivery and transport teams, and limiting the number of providers in direct contact with any patient who is infected or whose infection status is unknown. Learning objectives: 1.To understand specific challenges caused by the COVID-19 pandemic for patients with congenital heart disease needing urgent neonatal intervention.2.To recognize measures that can be taken to minimize health care workers' exposures to the virus during high-risk neonatal cardiac procedures.3.To review the management of neonates with d-transposition of the great arteries and inadequate mixing.
Keywords	covid19
Language	English
Publishing date	2020-06-25
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	1171597-2
ISSN	1558-1519 ; 1058-9813
ISSN (online)	1558-1519
ISSN	1058-9813
DOI	10.1016/j.ppedcard.2020.101265
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Article ; Online: Survival of Three Neonates With Congenital Diaphragmatic Hernia and d-Transposition of the Great Arteries.

Blancha, Victoria L / Ratner, Veniamin / Aspelund, Gudrun / Chai, Paul / Levasseur, Stéphanie / Krishnan, Usha / Bacha, Emile / Krishnamurthy, Ganga

World journal for pediatric & congenital heart surgery

2017 Volume 8, Issue 2, Page(s) 239–241

Abstract: Survival is significantly compromised in infants born with congenital diaphragmatic hernia and major cardiac anomalies. Mortality is highest when congenital diaphragmatic hernia occurs in association with d-transposition of the great arteries. We present ...

Abstract	Survival is significantly compromised in infants born with congenital diaphragmatic hernia and major cardiac anomalies. Mortality is highest when congenital diaphragmatic hernia occurs in association with d-transposition of the great arteries. We present three infants with congenital diaphragmatic hernia associated with d-transposition of the great arteries from a single institution. All three infants survived to discharge after surgical repair/palliation of both the diaphragmatic hernia and heart defect and are doing well at last follow-up. The clinical course and management of these three patients are described.
MeSH term(s)	Cardiac Surgical Procedures/methods ; Female ; Hernias, Diaphragmatic, Congenital/diagnosis ; Hernias, Diaphragmatic, Congenital/surgery ; Humans ; Infant, Newborn ; Male ; Survivors ; Transposition of Great Vessels/diagnosis ; Transposition of Great Vessels/surgery
Language	English
Publishing date	2017-03
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2550261-X
ISSN	2150-136X ; 2150-1351
ISSN (online)	2150-136X
ISSN	2150-1351
DOI	10.1177/2150135116632509
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Article ; Online: Parents of children with congenital heart disease prefer more information than cardiologists provide.

Arya, Bhawna / Glickstein, Julie S / Levasseur, Stéphanie M / Williams, Ismeé A

Congenital heart disease

2012 Volume 8, Issue 1, Page(s) 78–85

Abstract: Objectives: To determine whether pediatric cardiologists and parents of older children with congenital heart disease (CHD) share similar expectations regarding the education and counseling that should be provided to parents of children with CHD in both ... ...

Abstract	Objectives: To determine whether pediatric cardiologists and parents of older children with congenital heart disease (CHD) share similar expectations regarding the education and counseling that should be provided to parents of children with CHD in both the prenatal and neonatal period. Design: Consenting parents of older children with CHD (age >3 years) and cardiologists ranked the importance of education topics on a scale of 1 (unimportant) to 10 (very important). The rankings of parents and cardiologists were compared using Student's t-test. Results: We had 38 cardiologists and 41 parents complete the questionnaire. There was a statistically significant difference in rankings between cardiologist and parents of children with CHD (P<0.03). Parents consistently ranked topics as more important than cardiologists with a mean difference in rank score of 0.85 ±0.3. In the prenatal period, the most significant differences between parents and cardiologists were noted for information related to the child's quality of life. For neonatal counseling, the most significant differences were noted for information regarding follow-up care and the parent's ability to describe the child's CHD to medical personnel. Conclusion: Parents of older children with CHD would prefer to receive more counseling and education in the prenatal and newborn period than cardiologists perceive is wanted.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Counseling ; Decision Making ; Heart Defects, Congenital/diagnosis ; Humans ; Information Seeking Behavior ; Parents/psychology ; Patient Education as Topic ; Physician-Patient Relations ; Prenatal Diagnosis
Language	English
Publishing date	2012-08-14
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2274321-2
ISSN	1747-0803 ; 1747-079X
ISSN (online)	1747-0803
ISSN	1747-079X
DOI	10.1111/j.1747-0803.2012.00706.x
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Article ; Online: Impact of Coronavirus Disease 2019 (COVID-19) on Patients With Congenital Heart Disease Across the Lifespan: The Experience of an Academic Congenital Heart Disease Center in New York City.

Lewis, Matthew J / Anderson, Brett R / Fremed, Michael / Argenio, Melissa / Krishnan, Usha / Weller, Rachel / Levasseur, Stéphanie / Sommer, Robert / Lytrivi, Irene D / Bacha, Emile A / Vincent, Julie / Chung, Wendy K / Rosenzweig, Erika B / Starc, Thomas J / Rosenbaum, Marlon

Journal of the American Heart Association

2020 Volume 9, Issue 23, Page(s) e017580

Abstract: Background We sought to assess the impact and predictors of coronavirus disease 2019 (COVID-19) infection and severity in a cohort of patients with congenital heart disease (CHD) at a large CHD center in New York City. Methods and Results We performed a ... ...

Abstract	Background We sought to assess the impact and predictors of coronavirus disease 2019 (COVID-19) infection and severity in a cohort of patients with congenital heart disease (CHD) at a large CHD center in New York City. Methods and Results We performed a retrospective review of all individuals with CHD followed at Columbia University Irving Medical Center who were diagnosed with COVID-19 between March 1, 2020 and July 1, 2020. The primary end point was moderate/severe response to COVID-19 infection defined as (1) death during COVID-19 infection; or (2) need for hospitalization and/or respiratory support secondary to COVID-19 infection. Among 53 COVID-19-positive patients with CHD, 10 (19%) were <18 years of age (median age 34 years of age). Thirty-one (58%) had complex congenital anatomy including 10 (19%) with a Fontan repair. Eight (15%) had a genetic syndrome, 6 (11%) had pulmonary hypertension, and 9 (17%) were obese. Among adults, 18 (41%) were physiologic class C or D. For the entire cohort, 9 (17%) had a moderate/severe infection, including 3 deaths (6%). After correcting for multiple comparisons, the presence of a genetic syndrome (odds ratio [OR], 35.82;
MeSH term(s)	Academic Medical Centers ; Adult ; Aged ; Azithromycin/therapeutic use ; COVID-19/complications ; COVID-19/therapy ; Cohort Studies ; Female ; Genetic Diseases, Inborn/complications ; Heart Defects, Congenital/classification ; Heart Defects, Congenital/complications ; Hospitalization/statistics & numerical data ; Humans ; Hydroxychloroquine/therapeutic use ; Intubation, Intratracheal/statistics & numerical data ; Male ; New York City ; Oxygen Inhalation Therapy/statistics & numerical data ; Retrospective Studies ; Severity of Illness Index ; Young Adult
Chemical Substances	Hydroxychloroquine (4QWG6N8QKH) ; Azithromycin (83905-01-5)
Keywords	covid19
Language	English
Publishing date	2020-10-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.120.017580
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