BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
Adult ; Blood Transfusion ; Bloodless Medical and Surgical Procedures* ; Heart Valves* ; Humans ; Jehovah's Witnesses* ; Mortality ; Perioperative Care ; Survival Rate

The Ross operation, a procedure of replacement of the diseased aortic valve with an autologous pulmonary valve, has many advantages such as no need for anticoagulation therapy and similar valve function and growth potential as native valves. However secondary aortic disease has emerged as a significant complication and indication for reoperation. We report a 48-year-old woman who had Ross operation in 1997 for a damaged bicuspid aortic valve and severe aortic regurgitation due to subacute bacterial endocarditis complicated by aortic root abscess. In 2009, 12 years later, progressive severe aortic regurgitation with incomplete coaptation and mild dilatation of the aortic root was shown on echocardiography and contrasted CT, while the pulmonary homograft retained normal function. She subsequently underwent aortic valve replacement. Histopathological examination of the explanted neo-aortic valve and neo-arterial wall revealed pannus formation at the nodulus Arantii area of the three valve cusps, ventricularis, and arterialis. The amount of elastic fibres in the neo-aorta media was less than usual for an aorta of this patient's age but was similar to a pulmonary artery. The pathological findings were not different from other studies of specimens removed between 7 to 12 years after Ross operation. However, the pathophysiology and long-term implications of these findings remain debatable. Considering the anatomical and physiological changes induced by the procedure, separate mechanisms for aortic dilatation and regurgitation are worthy of consideration.
Aorta/*pathology ; Aortic Valve/*surgery ; Aortic Valve Insufficiency/*etiology ; Cardiovascular Surgical Procedures/*adverse effects ; Dilatation, Pathologic ; Heart Valve Diseases/*surgery ; Prostheses and Implants ; Pulmonary Valve/*transplantation

No abstract available.
De Lange Syndrome*

Infective endocarditis includes conditions in which the structure of the heart, most frequently the valves, harbors an infective process that leads to valvular dysfunction, localized or generalized sepsis, or sites for embolism. Predisposing factors for infective endocarditis are cardiac abnormalities that disrupt the endocardium by means of a jet injury as well as the presence of blood-born microorganisms that colonize these abnormal surfaces. Clinical features are present when defined in accordance with the New York Heart Association criteria, positive blood culture associated with either new or changing murmur or with embolic phenomena, or new or changing murmur in a patient with a congenital cardiac anomaly or with prior valve damage, associated with either embolic phenomena or sustained fever, anemia, and splenomegaly. Goals of operative therapy are to 1) remove infected tissue and drain abscess, 2) restore or reconstruct atrioventricular or ventriculoarterial continuity and 3) reverse the hemodynamic abnormality. The prognosis of infective endocarditis depends largely on when the disease is diagnosed and how promptly it is treated. The results of surgery for infective endocarditis have improved significantly during the past three decades. In a recent series of surgically treated patients, the operative mortality for native valve endocarditis was under 10% and for prosthetic valve endocarditis was 20% to 30%. This article reviewed the recent tends of surgical techniques and results of infective endocarditis and Sejong General Hospital experience in the past 10 years.
Abscess ; Anemia ; Causality ; Colon ; Embolism ; Endocarditis* ; Endocardium ; Fever ; Heart ; Heart Valves ; Hemodynamics ; Hospitals, General ; Humans ; Mortality ; Prognosis ; Sepsis ; Splenomegaly

Infective endocarditis includes conditions in which the structure of the heart, most frequently the valves, harbors an infective process that leads to valvular dysfunction, localized or generalized sepsis, or sites for embolism. Predisposing factors for infective endocarditis are cardiac abnormalities that disrupt the endocardium by means of a jet injury as well as the presence of blood-born microorganisms that colonize these abnormal surfaces. Clinical features are present when defined in accordance with the New York Heart Association criteria, positive blood culture associated with either new or changing murmur or with embolic phenomena, or new or changing murmur in a patient with a congenital cardiac anomaly or with prior valve damage, associated with either embolic phenomena or sustained fever, anemia, and splenomegaly. Goals of operative therapy are to 1) remove infected tissue and drain abscess, 2) restore or reconstruct atrioventricular or ventriculoarterial continuity and 3) reverse the hemodynamic abnormality. The prognosis of infective endocarditis depends largely on when the disease is diagnosed and how promptly it is treated. The results of surgery for infective endocarditis have improved significantly during the past three decades. In a recent series of surgically treated patients, the operative mortality for native valve endocarditis was under 10% and for prosthetic valve endocarditis was 20% to 30%. This article reviewed the recent tends of surgical techniques and results of infective endocarditis and Sejong General Hospital experience in the past 10 years.
Abscess ; Anemia ; Causality ; Colon ; Embolism ; Endocarditis* ; Endocardium ; Fever ; Heart ; Heart Valves ; Hemodynamics ; Hospitals, General ; Humans ; Mortality ; Prognosis ; Sepsis ; Splenomegaly

Objective: : Anterior communicating artery (Acom) aneurysm is one of the most common intracranial aneurysms, constituting approximately 30–35% of all aneurysm formation in the brain. Anatomically, the H-complex (the anatomic morphology of both A1 to A2 segments) is thought to affects the nature of the Acom aneurysm due to its close relationship with the hemodynamics of the vessel. Therefore, we investigated the relative risk factors of aneurysmal rupture, especially focusing on H-complex morphology of the Acom. Methods: : From January 2016 to December 2020, a total of 209 patients who underwent surgery, including clipping and coiling for Acom aneurysm in our institution were reviewed. There were 102 cases of ruptured aneurysm and 107 cases of unruptured aneurysm. The baseline morphology of aneurysms was investigated and the relationship between the H-complex and the clinical characteristics of patients with Acom aneurysms was assessed. Results: : Of the 209 patients, 109 patients (52.1%) had symmetrical A1, 79 patients (37.8%) had unilateral hypoplastic A1, and 21 patients (10.0%) had aplastic A1. The hypoplastic A1 group and the aplastic A1 group were grouped together as unilateral dominancy of A1, and were compared with the symmetrical A1 group. There was no significant difference in demographic characteristics and radiological findings of Acom aneurysms between two groups. However, when dichotomizing the patients into ruptured cases and unruptured cases, unilateral dominance of the A1 segment was associated with aneurysmal rupture with statistical significance (p=0.011). Conclusion : These results suggest that the unilateral dominance of the A1 segment does not have a significant effect on the morphology of Acom aneurysms, but contributes to aneurysmal rupture. Thus, we can better understand the effects of hemodynamics on Acom aneurysm.

Cardiac papillary fibroelastomas are the second most common primary cardiac tumor. This tumor is usually benign and it involves the cardiac valve. However, most cardiac papillary fibroelastomas originate from a single site, and the incidence of cardiac papillary fibroelastomas originating from multiple sites is very rare (5%). A 55-year-old woman who presented with momentary dizziness and syncope was evaluated by performing echocardiography. Multiple tumors attached to the aortic valve were noted. The mass was removed freely without leaving any defect on the aortic valve leaflet. After the recovery period, the patient is currently being followed up at the outpatient department.
Aortic Valve ; Dizziness ; Echocardiography ; Female ; Heart Neoplasms ; Heart Valves ; Humans ; Incidence ; Middle Aged ; Outpatients ; Syncope

PURPOSE: It is very rare to observe the thrombus formation next to the ateriovenous crossing(AV crossing) in branch retinal vein occlusion(BRVO). We investigated two cases with the thrombus in BRVO. MATERIALS AND METHODS: Two of 347 cases with BRVO to perform the fluorescein angiography(FAG) were observed to form the intravascular thrombus next to the AV crossing. RESULTS: The vascular wall in the area of thrombus was hyperfluorescent in FAG. The fluorescence was visible in the early arteriovenous phase and it increased in the mid-phase of the angiogram. Investigatons for systemic hypertension and hyperlipidemia in two cases were positive. The vascular wall in the area of thrombus in one case revealed as hyperfluorescence exaggeratedly in length by forward and backward movement of the thrombus during performing FAG. And the leakage of fluorescein from the venule next to the AV crossing was not observed. In the other case, the vascular wall in the area of thrombus revealed the small hyperfluorescent spot and the leakage of fluorescein. CONCLUSIONS: The pathogenesis of thrombus formation in the retinal vein resulting in retinal vein occlusion is not well understood. Although poststenotic turbulence of blood flow after an AV crossing or a preexisting vessel wall alteration combined with alterations of blood fluidity may induce thrombus formation, it was uncertain in our cases whether or not the thrombus formation was associated with hyperlipidemia, systemic hypertension, and hypercoaguable states.
Fluorescein ; Fluorescence ; Hyperlipidemias ; Hypertension ; Retina* ; Retinal Vein ; Retinal Vein Occlusion ; Thrombosis* ; Veins* ; Venules

FDT is known as a comfortable and convenient device, and there was no restriction in pupil size and refractive error within 7 diopters.To compare the effectiveness of secreening and N-30 mode in FDT, new field analyzer. Twenty-three POAG or ocular hypertension patients(43 eyes)were included in this study. All subjects underwent FDT screening and N-30 15 minutes apart on same day within 1 month after HFA C30-2 test. Mean age of the subjects was 49.77+/-11.61 years. Fifteen men and nine woman were included in this study. Test duration was 52.3+/-6.2 seconds with FDT screening, 5.46+/-0.32 minutes with FDT N-30, and 14.46+/-1.88 minutes with HFA C30-2.In global indexes MD and PSD of FDT N-30 were well correlated with MD, PSD, and CPSD of HFA C30-2 respectively(p<0.01). In diagnosing glaucoma, sensitivity of FDT screening and N-30 was 75% and 88%respectively, and specificity of screening and N-30 was 94%and 82%respectively. In detecting defect in each test location, sensitivity of FDT screening and N-30 was 68.6%and 81.6%respectively, and specificity of screening and N-30 was 94.5%and 83.8%respectively. FDT N-30 mode appears to be superior to FDT screening mode in screening and diagnosing glaucoma as there are high correlation with HFA C30-2, good sensitivity, and specificity inspite of longer test duration.
Female ; Glaucoma ; Humans ; Male ; Mass Screening* ; Ocular Hypertension ; Pupil ; Refractive Errors ; Sensitivity and Specificity ; Visual Field Tests*

The Kniest syndrome is characterized by disproportionate dwarfism and Kyphoscoliosis which may be associated with flat facies with prominent eyes, cleft palate, hearing loss, myopia and limited joint motion. The skeletal abnormalities are recognizable at birth with shortening and deformity of the extremities and stiff joints. Marked lumbar lordosis and kyphoscoliosis develop in childhood, resulting in disproportionate shortening of the trunk. We experienced a case of kniest syndrome, confirmed by clinical features, radiological features, and histological examination of cartilage. A brief review of the related literature is presented.
Animals ; Cartilage ; Cleft Palate ; Congenital Abnormalities ; Dwarfism ; Extremities ; Facies ; Hearing Loss ; Joints ; Lordosis ; Myopia ; Parturition