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.

BACKGROUND: AMBU bag is a useful equipment in the cardiopulmonary resuscitation(CPR) and respiratory therapy. The volume delivered during ventilation with AMBU bag may be influenced by many factors. METHOD: We evaluated the effects of ventilation method(one-hand, open-palm, two-hand) and resuscitator's sex on volume in 30 intubated patients under general anesthesia with inhalational anesthetics and muscle relaxants. RESULTS: Mean tidal volume was significantly greater with two-hand method than one-hand and open-palm method in both sex. PaO2 was significantly decreased in all ventilation methods. PaCO2 was also decreased and pH was increased in all methods. CONCLUSION: The results suggest that all ventilation methods with AMBU bag in intubated patients may suitable in the CPR. If airway management by intubation is impossible and mask ventilation, two-hand method may be effective in both resuscitator but open-palm method may not suitable to female resuscitator.
Airway Management ; Anesthesia, General ; Anesthetics ; Cardiopulmonary Resuscitation ; Female ; Humans* ; Hydrogen-Ion Concentration ; Intubation ; Isoflurane* ; Masks ; One-Lung Ventilation* ; Respiratory Therapy ; Resuscitation ; Tidal Volume ; Ventilation

BACKGROUND: AMBU bag is a useful equipment in the cardiopulmonary resuscitation(CPR) and respiratory therapy. The volume delivered during ventilation with AMBU bag may be influenced by many factors. METHOD: We evaluated the effects of ventilation method(one-hand, open-palm, two-hand) and resuscitator's sex on volume in 30 intubated patients under general anesthesia with inhalational anesthetics and muscle relaxants. RESULTS: Mean tidal volume was significantly greater with two-hand method than one-hand and open-palm method in both sex. PaO2 was significantly decreased in all ventilation methods. PaCO2 was also decreased and pH was increased in all methods. CONCLUSION: The results suggest that all ventilation methods with AMBU bag in intubated patients may suitable in the CPR. If airway management by intubation is impossible and mask ventilation, two-hand method may be effective in both resuscitator but open-palm method may not suitable to female resuscitator.
Airway Management ; Anesthesia, General ; Anesthetics ; Cardiopulmonary Resuscitation ; Female ; Humans* ; Hydrogen-Ion Concentration ; Intubation ; Isoflurane* ; Masks ; One-Lung Ventilation* ; Respiratory Therapy ; Resuscitation ; Tidal Volume ; Ventilation

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

With increasing number of high-risk, advanced atherosclerotic patients, crossover femoro-femoral bypass (FFB) became commonly chosen extra-anatomic bypass for symptomatic iliac artery occlusive disease. But the causes FFB graft failure have not been clarified yet. PURPOSE: We aimed to investigate the natural course of native artery disease, the causes of graft occlusion and recurrent leg ischemia after FFBs. METHOD: Among 162 primary FFBs for atherosclerotic iliac occlusive disease, 45 patients who underwent follow-up arteriography for recurrent ischemic symptom were enrolled. We investigated the interval changes between initial preoperative and follow-up angiograms and categorized them as inflow, outflow and/or graft lesions. The significant changes between 2 angiograms was arbitrarily defined as progression of lesion into stenosis >50% or occlusion. And the patients were divided into 2 groups as patent FFB group and occluded FFB group. We compared interval changes on angiograms between patient and occluded FFB groups to find out any difference and tried to determine the ultimate causes of recurrent leg ischemia considering not only the interval changes but the preexisting, untreated leg arterial lesions. RESULT: The follow-up angiography was most commonly performed within 1 year after FFB with mean interval of 21.2 +/- 21.6 months. Interval changes between 2 angiograms were 24 (53.3%) FFB grafts occlusion, 8 (17.8%) inflow iliac disease progression, and 26 (57.8%) ouflow arterial occlusion. Comparing the interval changes between patent and occluded FFB groups, the significantly higher frequency of outflow occlusion was noted in occluded FFB group (75% vs 38.1%, P=0.012). The most common finding on follow-up angiongram responsible for the recurrent ischemia was also outflow arterial occlusion even in patent FFB group. CONCLUSION: The most common cause of graft occlusion and recurrent leg ischemia was outflow arterial occlusion after FFB.
Angiography ; Arteries ; Constriction, Pathologic ; Disease Progression ; Follow-Up Studies ; Humans ; Iliac Artery ; Ischemia* ; Leg* ; Transplants*