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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="StatPearls [Internet]" /><meta name="citation_title" content="Anatomy, Thorax, Heart Pulmonary Arteries" /><meta name="citation_publisher" content="StatPearls Publishing" /><meta name="citation_date" content="2023/07/24" /><meta name="citation_author" content="William D. Tucker" /><meta name="citation_author" content="Carly Weber" /><meta name="citation_author" content="Bracken Burns" /><meta name="citation_pmid" content="30521233" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK534812/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Anatomy, Thorax, Heart Pulmonary Arteries" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="StatPearls Publishing" /><meta name="DC.Contributor" content="William D. Tucker" /><meta name="DC.Contributor" content="Carly Weber" /><meta name="DC.Contributor" content="Bracken Burns" /><meta name="DC.Date" content="2023/07/24" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK534812/" /><meta name="description" content="The main pulmonary artery and the subsequent right and left pulmonary arteries sit within the middle mediastinum. They arise from the right ventricle of the four-chambered heart and transport blood to the lungs. De-oxygenated blood from the body's somatic cells travels to the right atrium, then into the right ventricle, and through the main pulmonary artery and its branches before blood enters the lungs for oxygenation and gas exchange. These steps are all prerequisites for normal human physiologic function." /><meta name="og:title" content="Anatomy, Thorax, Heart Pulmonary Arteries" /><meta name="og:type" content="book" /><meta name="og:description" content="The main pulmonary artery and the subsequent right and left pulmonary arteries sit within the middle mediastinum. They arise from the right ventricle of the four-chambered heart and transport blood to the lungs. De-oxygenated blood from the body's somatic cells travels to the right atrium, then into the right ventricle, and through the main pulmonary artery and its branches before blood enters the lungs for oxygenation and gas exchange. These steps are all prerequisites for normal human physiologic function." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK534812/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/statpearls/article-28002/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK534812/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. </p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK534812_"><span class="title" itemprop="name">Anatomy, Thorax, Heart Pulmonary Arteries</span></h1><p class="contrib-group"><h4>Authors</h4><span itemprop="author">William D. Tucker</span><sup>1</sup>; <span itemprop="author">Carly Weber</span><sup>2</sup>; <span itemprop="author">Bracken Burns</span><sup>3</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> ETSU Quillen College of Medicine</div><div class="affiliation"><sup>2</sup> Lake Erie College of Osteopathic Medicine</div><div class="affiliation"><sup>3</sup> East Tennessee State University (ETSU)</div><p class="small">Last Update: <span itemprop="dateModified">July 24, 2023</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="article-28002.s1"><h2 id="_article-28002_s1_">Introduction</h2><p>The main pulmonary artery and the subsequent right and left pulmonary arteries sit within the middle mediastinum. They arise from the right ventricle of the four-chambered heart and transport blood to the lungs. De-oxygenated blood from the body's somatic cells travels to the right atrium, then into the right ventricle, and through the main pulmonary artery and its branches before blood enters the lungs for oxygenation and gas exchange. These steps are all prerequisites for normal human physiologic function.</p></div><div id="article-28002.s2"><h2 id="_article-28002_s2_">Structure and Function</h2><p>The pulmonary arteries function to transport deoxygenated blood from the right side of the heart to the lungs for oxygenation. These vessels serve as the conduit between the right side of the heart and the lungs. The right and left pulmonary arteries specifically provide blood flow to their respective lungs and further subdivide into the lobar, segmental, and sub-segmental arteries of the lungs before eventually becoming capillaries surrounded by alveoli. Described as a high capacitance, low-pressure system, the pulmonary circulation is ideal for optimal gas exchange.<a class="bk_pop" href="#article-28002.r1">[1]</a></p><p>As it leaves the right ventricle, the main pulmonary artery is typically short and wide. The main pulmonary artery is usually approximately 5 centimeters in length and 2-3 centimeters in diameter. The main pulmonary artery generally travels along the left of the ascending aorta as the great vessels leave the heart. It bifurcates at the level of the carina (T4 vertebral level) and just below the aortic arch at approximately a right angle to form the right and left pulmonary arteries.<a class="bk_pop" href="#article-28002.r1">[1]</a></p><p>The right pulmonary artery supplies the right lung while the left pulmonary artery supplies the left lung. The right pulmonary artery courses posterior to the ascending aorta and anterior to the descending aorta. It lies anterior to the right mainstem bronchus. The left pulmonary artery passes anterior to the descending aorta and lies superior to the left mainstem bronchus.</p><p>A common mnemonic used to remember the relationship between the pulmonary arteries and their respective mainstem bronchi is RALS meaning, the right pulmonary artery lies anterior to the right mainstem bronchus, and the left pulmonary artery lies superior to the left mainstem bronchus.</p></div><div id="article-28002.s3"><h2 id="_article-28002_s3_">Embryology</h2><p>Understanding the embryology of the pulmonary artery is imperative to demonstrate thorough anatomic knowledge on the subject. The most critical embryological components in the formation of the main pulmonary artery and the right and left pulmonary arteries are the sixth aortic arch, the truncus arteriosus, the conus cordis, and neural crest cells.<a class="bk_pop" href="#article-28002.r2">[2]</a></p><p>The sixth aortic arch gives rise to both the right and left pulmonary arteries and the ligamentum arteriosum. The ligamentum arteriosum is the ductus arteriosus during fetal development. The ductus arteriosus serves to allow oxygenated fetal blood to bypass the developing lungs and move directly into the aorta. Both the right and left sixth aortic arches initially contribute to the development of pulmonary arterial flow, but as the right-sided arch degenerates, the left sixth arch contributes the vasculature for both pulmonary arteries.</p><p>The intricate relationship of the truncus arteriosus, conus cordis, and neural crest cells in the fifth week of fetal development coordinates the proper formation of the right and left ventricular outflow tracts, the main pulmonary artery and ascending aorta, respectively.</p><p>Oppositional ridges form within the truncus arteriosus: one along the right superior aspect and the other along the left inferior aspect. The right ridge progresses distally and leftward, while the left ridge progresses distally and rightward, twisting as they meet. Simultaneously, oppositional swellings develop within the conus cordis along the right dorsal and left ventral aspects. Each of these ridges, or swellings, acts under the influence of neural crest cells. As the truncal ridges converge, they divide the truncus arteriosus into the main pulmonary artery and the ascending aorta. When the conus ridges converge, they form the right ventricular outflow tract, positioned anterolaterally, and the left ventricular outflow tract, positioned posteromedially.</p></div><div id="article-28002.s4"><h2 id="_article-28002_s4_">Blood Supply and Lymphatics</h2><p>Vasa vasorum supply the pulmonary artery wall with oxygen and nutrients, while venous vasa vasorum clear waste products with venous drainage.<a class="bk_pop" href="#article-28002.r3">[3]</a></p><p>The lymphatics of the pulmonary artery drain to the visceral thoracic nodal system, specifically the mediastinal lymph nodes.</p></div><div id="article-28002.s5"><h2 id="_article-28002_s5_">Nerves</h2><p>Innervation of the pulmonary artery is like that of other vessels. The cardiac nervous plexus supplies sympathetic and parasympathetic innervation. The nerve plexus is situated anterior to the bifurcation of the trachea and posterior to the splitting of the left and right pulmonary arteries. The sympathetic supply comes from both cervical and thoracic segments of the spinal cord. The vagus nerve supplies parasympathetic innervation.</p></div><div id="article-28002.s6"><h2 id="_article-28002_s6_">Muscles</h2><p>Smooth muscles within the tunica media of the arterial wall comprise the musculature of the pulmonary artery and its branches.<a class="bk_pop" href="#article-28002.r4">[4]</a></p></div><div id="article-28002.s7"><h2 id="_article-28002_s7_">Physiologic Variants</h2><p>Vascular anatomy is always subject to anatomic variation, and the pulmonary arterial vasculature is no exception. Pulmonary artery variants are usually discovered as incidental findings on imaging.</p><p>A well-documented variant of pulmonary arterial anatomy is the aberrant left pulmonary artery, also known as the pulmonary sling. In this variation, the left pulmonary artery arises from the posterior aspect of the right pulmonary artery and passes superior to the right mainstem bronchus and between the esophagus and trachea.<a class="bk_pop" href="#article-28002.r5">[5]</a></p><p>Another variant is unilateral proximal artery interruption. Here the pulmonary artery, right more commonly than left, ends blindly as it enters the lung hilum, although the vasculature within the lung itself is patent. To compensate for the interrupted artery, the bronchial arteries supplying the affected lung will hypertrophy and participate in gas exchange. Transpleural arteries may also develop to further compensate for the decreased flow.<a class="bk_pop" href="#article-28002.r6">[6]</a></p><p>One more variant of pulmonary artery anatomy is the idiopathic dilatation of the pulmonary artery (IDPA). This diagnosis may or may not involve dilatation of the right and left pulmonary arteries and requires the exclusion of other causes of pulmonary artery distension or enlargement.<a class="bk_pop" href="#article-28002.r7">[7]</a></p><p>Anatomic variation of the segmental and subsegmental pulmonary arteries is much more common.</p></div><div id="article-28002.s8"><h2 id="_article-28002_s8_">Surgical Considerations</h2><p>Understanding pulmonary artery anatomy is essential for all cardiothoracic surgery. Any surgical work done in and around the pulmonary artery puts at risk the other nearby structures of the heart and lungs, and iatrogenic injury to a pulmonary artery can have immediate and grave consequences.</p><p>Many surgeries directly involve the pulmonary arteries or the main pulmonary trunk. Congenital diseases requiring repair that involve the pulmonary artery and trunk are numerous and include: Tetralogy of Fallot, pulmonary atresia, pulmonary stenosis, double outlet right ventricle, truncus arteriosus, transposition of the great arteries, and patent ductus arteriosus. Pulmonic valve replacement, although rare in adults, involves access through the right ventricular outflow tract and affects the pulmonary trunk.</p><p>An operation directly involving the pulmonary arteries and their more distal branches is the pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Additionally, the pulmonary arteries can be the site of emboli that, if clinically significant, may require either surgical or catheter-directed embolectomy.</p><p>The above is not an extensive list of the surgical procedures or considerations involving the pulmonary trunk and arteries.</p></div><div id="article-28002.s9"><h2 id="_article-28002_s9_">Clinical Significance</h2><p>There are multiple clinical scenarios in which the pulmonary trunk and the pulmonary arteries play a significant role. Some of these pathological states are congenital, while others result from the adult-onset disease.</p><p>Pulmonary artery pressures can be measured with a Swan-Ganz catheter and provide important data in determining the extent of lung and left-sided heart disease. Mitral valve disease and aortic valve disease can cause extreme increases in pulmonary artery pressure and reflect the stress placed on the right-sided heart.</p><p>Pulmonary diseases, like pulmonary arterial hypertension, also cause increased pulmonary artery pressures. Again, these increased pressures are a direct reflection of the increased stresses on the right heart.<a class="bk_pop" href="#article-28002.r8">[8]</a></p><p>A saddle pulmonary embolism can cause rapid onset of hemodynamic instability and be a rare cause of sudden death. An embolus, or clot, lodged in the bifurcation of the main pulmonary artery and occluding the lumen of the pulmonary arteries on both the right and the left is termed a saddle pulmonary embolism.<a class="bk_pop" href="#article-28002.r9">[9]</a></p><p>Congenital diseases like persistent truncus arteriosus and transposition of the great vessels are directly attributable to a failure of normal embryologic development involving the pulmonary artery.</p></div><div id="article-28002.s10"><h2 id="_article-28002_s10_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div class="floats-group" id="article-28002.s11"></div><div class="floats-group" id="article-28002.s12"></div><div id="article-28002.s13"><h2 id="_article-28002_s13_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="article-28002.r1">Kandathil A, Chamarthy M. Pulmonary vascular anatomy & anatomical variants. <span><span class="ref-journal">Cardiovasc Diagn Ther. </span>2018 Jun;<span class="ref-vol">8</span>(3):201-207.</span> [<a href="/pmc/articles/PMC6039811/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6039811</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30057869" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30057869</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="article-28002.r2">Murillo H, Cutalo MJ, Jones RP, Lane MJ, Fleischmann D, Restrepo CS. Pulmonary circulation imaging: embryology and normal anatomy. <span><span class="ref-journal">Semin Ultrasound CT MR. </span>2012 Dec;<span class="ref-vol">33</span>(6):473-84.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23168059" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23168059</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="article-28002.r3">Parke WW. The vasa vasorum of the ascending aorta and pulmonary trunk and their coronary-extracardiac relationships. <span><span class="ref-journal">Am Heart J. </span>1970 Dec;<span class="ref-vol">80</span>(6):802-10.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/5529331" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5529331</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="article-28002.r4">Tucker WD, Arora Y, Mahajan K. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Anatomy, Blood Vessels. [<a href="https://pubmed.ncbi.nlm.nih.gov/29262226" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29262226</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="article-28002.r5">Backer CL, Idriss FS, Holinger LD, Mavroudis C. Pulmonary artery sling. Results of surgical repair in infancy. <span><span class="ref-journal">J Thorac Cardiovasc Surg. </span>1992 Apr;<span class="ref-vol">103</span>(4):683-91.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1548911" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1548911</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="article-28002.r6">Kieffer SA, Amplatz K, Anderson RC, Lillehei CW. Proximal interruption of a pulmonary artery. <span><span class="ref-journal">Am J Roentgenol Radium Ther Nucl Med. </span>1965 Nov;<span class="ref-vol">95</span>(3):592-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/5844925" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5844925</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="article-28002.r7">Malviya A, Jha PK, Kalita JP, Saikia MK, Mishra A. Idiopathic dilatation of pulmonary artery: A review. <span><span class="ref-journal">Indian Heart J. </span>2017 Jan-Feb;<span class="ref-vol">69</span>(1):119-124.</span> [<a href="/pmc/articles/PMC5319124/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5319124</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28228295" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28228295</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="article-28002.r8">Frazier AA, Galvin JR, Franks TJ, Rosado-De-Christenson ML. From the archives of the AFIP: pulmonary vasculature: hypertension and infarction. <span><span class="ref-journal">Radiographics. </span>2000 Mar-Apr;<span class="ref-vol">20</span>(2):491-524; quiz 530-1, 532.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10715347" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10715347</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="article-28002.r9">Mayo JR, Remy-Jardin M, Müller NL, Remy J, Worsley DF, Hossein-Foucher C, Kwong JS, Brown MJ. Pulmonary embolism: prospective comparison of spiral CT with ventilation-perfusion scintigraphy. <span><span class="ref-journal">Radiology. </span>1997 Nov;<span class="ref-vol">205</span>(2):447-52.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9356627" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9356627</span></a>]</div></dd></dl></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>William Tucker declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Carly Weber declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Bracken Burns declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></div><div class="bk_prnt_sctn"><h2>Figures</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="article-28002.image.f1" class="figure bk_fig"><div class="graphic"><img src="/books/NBK534812/bin/Gray496.jpg" alt="Image Gray496" /></div><div class="caption"><p>Anatomy of the Heart from the left, Left Ventricle, Right Pulmonary Veins, Superior Vena Cava, Aorta, Pulmonary Artery, Left Auricula, Inferior Vena Cava Henry Vandyke Carter, Public Domain, via Wikimedia Commons</p></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="article-28002.image.f2" class="figure bk_fig"><div class="graphic"><img src="/books/NBK534812/bin/Gray975.jpg" alt="The Lungs" /></div><div class="caption"><p>The Lungs. This schematic longitudinal section of a primary lobule of the lung includes the respiratory bronchiole, alveolar duct, atria, alveolar sac, alveolus or air cell, pulmonary artery, pulmonary vein, lymphatic, and lymph node. Henry Vandyke Carter, <a href="https://commons.wikimedia.org/w/index.php?search=Gray+plate+975&title=Special:MediaSearch&go=Go&type=image" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Public Domain</a>, via Wikimedia Commons</p></div></div></div></div></div></div>
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||
</div>
|
||
</div>
|
||
<div class="bottom">
|
||
|
||
<div id="NCBIFooter_dynamic">
|
||
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
||
<component id="Breadcrumbs" label="helpdesk"/>-->
|
||
|
||
</div>
|
||
|
||
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
||
</div>
|
||
</div>
|
||
<!--/.page-->
|
||
</div>
|
||
<!--/.wrap-->
|
||
</div><!-- /.twelve_col -->
|
||
</div>
|
||
<!-- /.grid -->
|
||
|
||
<span class="PAFAppResources"></span>
|
||
|
||
<!-- BESelector tab -->
|
||
|
||
|
||
|
||
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK534812&ncbi_domain=statpearls&ncbi_report=printable&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK534812/?report=printable&ncbi_app=bookshelf" /></noscript>
|
||
|
||
|
||
<!-- usually for JS scripts at page bottom -->
|
||
<!--<component id="PageFixtures" label="styles"></component>-->
|
||
|
||
|
||
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal105 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
||
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
||
|
||
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/3400083/3426610.js" snapshot="books"></script></body>
|
||
</html> |