Case report: A rare case of congenital right coronary artery aneurysm with right coronary artery-to-left ventricle fistula

Case report: A rare case of congenital right coronary artery aneurysm with right coronary artery-to-left ventricle fistula | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Case report: A rare case of congenital right coronary artery aneurysm with right coronary artery-to-left ventricle fistula Xinyu Wang, Xu Chen, Yuanyuan Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4357340/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 4 You are reading this latest preprint version Abstract Patient, male, 33 years old, with a history of dyspnea on exertion for more than 10 years and chest pain for one month. Physical examination: Blood pressure 151/57 mmHg, heart rate 87 beats per minute, irregular rhythm, a Grade III/VI systolic murmur heard in the precordium. Electrocardiogram showed fragmented QRS complexes in the inferior leads and clockwise rotation. Upon admission, the initial transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) revealed left ventricular enlargement, diffuse aneurysmal dilatation of the right coronary artery (RCA) with a maximum diameter of approximately 38 mm. A fistula with a diameter of about 10 mm was observed in the basal segment of the left ventricular inferior wall, connecting to the aneurysmal RCA. Color Doppler flow imaging (CDFI) demonstrated a significant diastolic multicolored flow jet originating from the fistula, with a velocity of 2.1 m/s and a pressure gradient of 18 mmHg. The ejection fraction (EF) was measured at 65%(Fig.1). The ultrasound diagnosis suggested right coronary artery aneurysm with right coronary artery-to-left ventricle fistula (RCALVF). Case report Congenital right coronary artery aneurysm Right coronary artery-to-left ventricle fistula Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Main Text Patient, male, 33 years old, with a history of dyspnea on exertion for more than 10 years and chest pain for one month. Physical examination: Blood pressure 151/57 mmHg, heart rate 87 beats per minute, irregular rhythm, a Grade III/VI systolic murmur heard in the precordium. Electrocardiogram showed fragmented QRS complexes in the inferior leads and clockwise rotation. Upon admission, the initial transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) revealed left ventricular enlargement, diffuse aneurysmal dilatation of the right coronary artery (RCA) with a maximum diameter of approximately 38 mm. A fistula with a diameter of about 10 mm was observed in the basal segment of the left ventricular inferior wall, connecting to the aneurysmal RCA. Color Doppler flow imaging (CDFI) demonstrated a significant diastolic multicolored flow jet originating from the fistula, with a velocity of 2.1 m/s and a pressure gradient of 18 mmHg. The ejection fraction (EF) was measured at 65%(Fig.1). The ultrasound diagnosis suggested right coronary artery aneurysm with right coronary artery-to-left ventricle fistula (RCALVF). Fig.1 Figures A,B,C are pictures of TTE, revealed left ventricular enlargement, dilatation of RCA, CDFI demonstrated jet originating from the fistula with a velocity of 2.1 m/s; Figure D,E,F are TEE pictures, showed clearer visualization of the entire expansion of the RCA, as well as the size and border of the fistulae. Coronary angiography revealed a normal origin of the coronary arteries, with a dominant RCA. The left anterior descending artery (LAD) and left circumflex artery (LCX) appeared normal(Fig.2). However, the RCA exhibited abnormal development with a distal ventricular fistula. Cardiac CT angiography (CTA) confirmed the presence of a right coronary artery aneurysm and RCALVF, with no collateral circulation in the RCA(Fig.3). Fig.2 Coronary angiography revealed a normal origin of the coronary arteries, with a dominant RCA. The left anterior descending artery (LAD) and left circumflex artery (LCX) appeared normal. Fig.3 Cardiac CT angiography (CTA) confirmed the presence of a right coronary artery aneurysm and RCALVF, with no collateral circulation in the RCA. Three-dimensional reconstruction provides a more intuitive and complete picture of the tortuous course of the RCA. On October 24, 2023, the patient underwent a repair procedure for the coronary artery fistula (CAF). Intraoperatively, the right coronary artery was significantly aneurysmal and occupied the atrioventricular groove. The right coronary artery orifice was dilated to approximately 10 mm, and there was a communication between the right coronary artery and the left ventricular cavity. The fistula opening was located just below the midpoint of the posterior mitral valve leaflet and measured approximately 12×10 mm, with some surrounding calcification. After exploring the right coronary artery wall, no branches were found, and the fistula opening was exposed. A patch was used for continuous suturing to close the left ventricular side of the fistula(Fig.4). Immediate postoperative TEE showed sluggish blood flow within the dilated right coronary artery, with evidence of thrombus formation. On the first day after the surgery, a bedside TTE revealed no abnormal shunt signals within the left ventricle(Fig.5), and the EF was measured at 61%. The patient had an uneventful postoperative course and was discharged ten days later [1,2] . Fig.4 Intraoperatively, the right coronary artery was significantly aneurysmal(White arrow on the left), and there was a communication between the right coronary artery and the left ventricular cavity(White arrow on the right). Fig.5 Immediate postoperative TEE showed sluggish blood flow within the dilated right coronary artery, with evidence of thrombus formation(A,B). CTA one week postoperatively showed that the fistula had closed and no blood flow was seen in the RCA(C,D). Declarations Competing interests Disclosure of interest：Nothing to declare. Funding This study was supported by Xiamen Medical and Health Science and Technology Project (3502Z20194075). Authors' contributions Xinyu Wang was responsible for writing the article； Xu Chen was responsible for collecting medical records and downloading imaging data. Yuanyuan Sun was responsible for writing, revising and submitting the article. Authors' information (optional) Department of Ultrasound, Xiamen Cardiovascular Hospital Xiamen University, Xiamen 361000 *Corresponding author: Tel:18060905102 Fax: 0592-2992999 Email: [email protected] References Mads Ørbæk, Andersen MH, Smerup K, Munk, et al. Computed tomographic-based three-dimensional printing of giant coronary artery fistulas to guide surgical strategy: a case series. Eur Heart J Case Rep. 2023;8:1–6. Takahashi T, Wakatsuki T, Ise T, et al. Spontaneous thrombosis of a giant aneurysm complicated with the coronary-to-pulmonary artery fistula: a case report. Eur Heart J Case Rep. 2024;8(5):ytae227. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 11 Jun, 2024 Editor assigned by journal 11 Jun, 2024 Submission checks completed at journal 08 Jun, 2024 First submitted to journal 02 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4357340","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":313256536,"identity":"6dd375d2-c4e8-4a28-afb9-43715f40fa78","order_by":0,"name":"Xinyu Wang","email":"","orcid":"","institution":"Xiamen Cardiovascular Hospital Xiamen University","correspondingAuthor":false,"prefix":"","firstName":"Xinyu","middleName":"","lastName":"Wang","suffix":""},{"id":313256537,"identity":"462c5695-2424-4b76-94de-2f33fef2fe35","order_by":1,"name":"Xu Chen","email":"","orcid":"","institution":"Xiamen Cardiovascular Hospital Xiamen University","correspondingAuthor":false,"prefix":"","firstName":"Xu","middleName":"","lastName":"Chen","suffix":""},{"id":313256538,"identity":"0a4d1150-a1c1-446e-9eb1-9e5aea8672ac","order_by":2,"name":"Yuanyuan Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYLCCBDACgg8GNnYkaWFsnFGQlkyKRQyMzTwfDjE2EFIqH5F8dMPDHbV5/Oxnnz+2MTjAzMB++OgGfFoMb6Sl3Ug8c7xYsifdsDnH4A4fAw9QBK+WGTlmNxLbjiVuOJDGCNTyjJlBgseMOC37zz9jbLYwOMzYQEiLvARYS03iBgmgLQzEaDHgeQb0S9uBxBk3njHO7DFIS2Yj5Bf59uRjN3+21SX296cxfPjxx8aOn/3wMfy2HABThxEibPiUg21pAFN1hNSNglEwCkbBSAYAp/lSp0duC1MAAAAASUVORK5CYII=","orcid":"","institution":"Xiamen Cardiovascular Hospital Xiamen University","correspondingAuthor":true,"prefix":"","firstName":"Yuanyuan","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2024-05-02 07:06:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4357340/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4357340/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59216362,"identity":"c998c12d-2f89-4373-878d-bcf4691f3aee","added_by":"auto","created_at":"2024-06-27 19:06:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":387710,"visible":true,"origin":"","legend":"\u003cp\u003eFigures A,B,C are pictures of TTE, revealed left ventricular enlargement, dilatation of RCA, CDFI demonstrated jet originating from the fistula with a velocity of 2.1 m/s; Figure D,E,F are TEE pictures, showedclearer visualization of the entire expansion of the RCA, as well as the size and border of the fistulae.\u003c/p\u003e","description":"","filename":"FIG1.png","url":"https://assets-eu.researchsquare.com/files/rs-4357340/v1/fe28cf70141ea01b79df6cdf.png"},{"id":59216360,"identity":"aea05781-cc0d-4f72-89ab-fc3b595a7e9b","added_by":"auto","created_at":"2024-06-27 19:06:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":402538,"visible":true,"origin":"","legend":"\u003cp\u003eCoronary angiography revealed a normal origin of the coronary arteries, with a dominant RCA. The left anterior descending artery (LAD) and left circumflex artery (LCX) appeared normal.\u003c/p\u003e","description":"","filename":"FIG2.png","url":"https://assets-eu.researchsquare.com/files/rs-4357340/v1/b7739c3a18f4088735b2354f.png"},{"id":59216364,"identity":"95dd3471-07d4-4e24-873f-30e63e39316b","added_by":"auto","created_at":"2024-06-27 19:06:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":570503,"visible":true,"origin":"","legend":"\u003cp\u003eCardiac CT angiography (CTA) confirmed the presence of a right coronary artery aneurysm and RCALVF, with no collateral circulation in the RCA. Three-dimensional reconstruction provides a more intuitive and complete picture of the tortuous course of the RCA.\u003c/p\u003e","description":"","filename":"FIG3.png","url":"https://assets-eu.researchsquare.com/files/rs-4357340/v1/87f1cf4c87e8bcfd1381848f.png"},{"id":59216361,"identity":"8e8f1d89-ab9a-41a1-ac7f-96dae252e380","added_by":"auto","created_at":"2024-06-27 19:06:19","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":843356,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperatively, the right coronary artery was significantly aneurysmal(White arrow on the left), and there was a communication between the right coronary artery and the left ventricular cavity(White arrow on the right).\u003c/p\u003e","description":"","filename":"FIG4.png","url":"https://assets-eu.researchsquare.com/files/rs-4357340/v1/2693f82c2dcd245f23ba0b1a.png"},{"id":59217271,"identity":"c1b7a934-1ec9-4c1f-a5f7-5c1fbf755977","added_by":"auto","created_at":"2024-06-27 19:14:19","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":578773,"visible":true,"origin":"","legend":"\u003cp\u003eImmediate postoperative TEE showed sluggish blood flow within the dilated right coronary artery, with evidence of thrombus formation(A,B). CTA one week postoperatively showed that the fistula had closed and no blood flow was seen in the RCA(C,D).\u003c/p\u003e","description":"","filename":"FIG5.png","url":"https://assets-eu.researchsquare.com/files/rs-4357340/v1/f450e124bad5cb4278b979f2.png"},{"id":59217272,"identity":"e0a57dd0-5036-4971-af1c-005b186ee6f2","added_by":"auto","created_at":"2024-06-27 19:14:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2783176,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4357340/v1/52bab519-f8aa-4e74-b880-186a668e3075.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Case report: A rare case of congenital right coronary artery aneurysm with right coronary artery-to-left ventricle fistula","fulltext":[{"header":"Main Text","content":"\u003cp\u003ePatient, male, 33 years old, with a history of dyspnea on exertion for more than 10 years and chest pain for one month. Physical examination: Blood pressure 151/57 mmHg, heart rate 87 beats per minute, irregular rhythm, a Grade III/VI systolic murmur heard in the precordium. Electrocardiogram showed fragmented QRS complexes in the inferior leads and clockwise rotation.\u003c/p\u003e\n\u003cp\u003eUpon admission, the initial transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) revealed left ventricular enlargement, diffuse aneurysmal dilatation of the right coronary artery (RCA) with a maximum diameter of approximately 38 mm. A fistula with a diameter of about 10 mm was observed in the basal segment of the left ventricular inferior wall, connecting to the aneurysmal RCA. Color Doppler flow imaging (CDFI) demonstrated a significant diastolic multicolored flow jet originating from the fistula, with a velocity of 2.1 m/s and a pressure gradient of 18 mmHg. The ejection fraction (EF) was measured at 65%(Fig.1). The ultrasound diagnosis suggested right coronary artery aneurysm with right coronary artery-to-left ventricle fistula (RCALVF).\u003c/p\u003e\n\u003cp\u003eFig.1\u003c/p\u003e\n\u003cp\u003eFigures A,B,C are pictures of TTE, revealed left ventricular enlargement, dilatation of RCA, CDFI demonstrated jet originating from the fistula with a velocity of 2.1 m/s; Figure D,E,F are TEE pictures, showed clearer visualization of the entire expansion of the RCA, as well as the size and border of the fistulae.\u003c/p\u003e\n\u003cp\u003eCoronary angiography revealed a normal origin of the coronary arteries, with a dominant RCA. The left anterior descending artery (LAD) and left circumflex artery (LCX) appeared normal(Fig.2). However, the RCA exhibited abnormal development with a distal ventricular fistula. Cardiac CT angiography (CTA) confirmed the presence of a right coronary artery aneurysm and RCALVF, with no collateral circulation in the RCA(Fig.3).\u003c/p\u003e\n\u003cp\u003eFig.2\u003c/p\u003e\n\u003cp\u003eCoronary angiography revealed a normal origin of the coronary arteries, with a dominant RCA. The left anterior descending artery (LAD) and left circumflex artery (LCX) appeared normal.\u003c/p\u003e\n\u003cp\u003eFig.3\u003c/p\u003e\n\u003cp\u003eCardiac CT angiography (CTA) confirmed the presence of a right coronary artery aneurysm and RCALVF, with no collateral circulation in the RCA. Three-dimensional reconstruction provides a more intuitive and complete picture of the tortuous course of the RCA.\u003c/p\u003e\n\u003cp\u003eOn October 24, 2023, the patient underwent a repair procedure for the coronary artery fistula (CAF). Intraoperatively, the right coronary artery was significantly aneurysmal and occupied the atrioventricular groove. The right coronary artery orifice was dilated to approximately 10 mm, and there was a communication between the right coronary artery and the left ventricular cavity. The fistula opening was located just below the midpoint of the posterior mitral valve leaflet and measured approximately 12\u0026times;10 mm, with some surrounding calcification. After exploring the right coronary artery wall, no branches were found, and the fistula opening was exposed. A patch was used for continuous suturing to close the left ventricular side of the fistula(Fig.4). Immediate postoperative TEE showed sluggish blood flow within the dilated right coronary artery, with evidence of thrombus formation. On the first day after the surgery, a bedside TTE revealed no abnormal shunt signals within the left ventricle(Fig.5), and the EF was measured at 61%. The patient had an uneventful postoperative course and was discharged ten days later\u003csup\u003e[1,2]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eFig.4\u003c/p\u003e\n\u003cp\u003eIntraoperatively, the right coronary artery was significantly aneurysmal(White arrow on the left), and there was a communication between the right coronary artery and the left ventricular cavity(White arrow on the right).\u003c/p\u003e\n\u003cp\u003eFig.5\u003c/p\u003e\n\u003cp\u003eImmediate postoperative TEE showed sluggish blood flow within the dilated right coronary artery, with evidence of thrombus formation(A,B). CTA one week postoperatively showed that the fistula had closed and no blood flow was seen in the RCA(C,D).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDisclosure of interest：Nothing to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Xiamen Medical and Health Science and Technology Project (3502Z20194075).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXinyu Wang was responsible for writing the article；\u003c/p\u003e\n\u003cp\u003eXu Chen was responsible for collecting medical records and downloading imaging data.\u003c/p\u003e\n\u003cp\u003eYuanyuan Sun was responsible for writing, revising and submitting the article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Ultrasound, Xiamen Cardiovascular Hospital Xiamen University, Xiamen 361000\u003c/p\u003e\n\u003cp\u003e*Corresponding author: Tel:18060905102 \u0026nbsp;Fax: 0592-2992999 \u0026nbsp;Email: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMads \u0026Oslash;rb\u0026aelig;k, Andersen MH, Smerup K, Munk, et al. Computed tomographic-based three-dimensional printing of giant coronary artery fistulas to guide surgical strategy: a case series. Eur Heart J Case Rep. 2023;8:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakahashi T, Wakatsuki T, Ise T, et al. Spontaneous thrombosis of a giant aneurysm complicated with the coronary-to-pulmonary artery fistula: a case report. 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Physical examination: Blood pressure 151/57 mmHg, heart rate 87 beats per minute, irregular rhythm, a Grade III/VI systolic murmur heard in the precordium. Electrocardiogram showed fragmented QRS complexes in the inferior leads and clockwise rotation.\u003c/p\u003e\n\u003cp\u003eUpon admission, the initial transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) revealed left ventricular enlargement, diffuse aneurysmal dilatation of the right coronary artery (RCA) with a maximum diameter of approximately 38 mm. A fistula with a diameter of about 10 mm was observed in the basal segment of the left ventricular inferior wall, connecting to the aneurysmal RCA. Color Doppler flow imaging (CDFI) demonstrated a significant diastolic multicolored flow jet originating from the fistula, with a velocity of 2.1 m/s and a pressure gradient of 18 mmHg. The ejection fraction (EF) was measured at 65%(Fig.1). The ultrasound diagnosis suggested right coronary artery aneurysm with right coronary artery-to-left ventricle fistula (RCALVF).\u003c/p\u003e","manuscriptTitle":"Case report: A rare case of congenital right coronary artery aneurysm with right coronary artery-to-left ventricle fistula","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-27 19:06:14","doi":"10.21203/rs.3.rs-4357340/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-11T17:08:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-11T11:33:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-08T13:51:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2024-05-02T07:03:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1e808fa-14c6-4295-9f83-52cbaabbe0e4","owner":[],"postedDate":"June 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T13:55:08+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-27 19:06:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4357340","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4357340","identity":"rs-4357340","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}