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A 74-year-old woman was referred for investigation of a 2-week history of progressive dyspnea. Her medical history included an aortic valve replacement with a stentless bioprosthesis followed 13 months later by the replacement of the aortic root with a porcine xenograft. Transesophageal echocardiography revealed a giant circular pseudoaneurysm of the aortic xenograft with compression of the prosthetic aortic valve and concomitant severe aortic regurgitation. Dehiscence of the proximal graft anastomosis was also diagnosed, and a possible distal anastomotic dehiscence was suspected. The latter turned out intraoperatively to be an almost complete dehiscence of the right coronary artery. The patient died intraoperatively. [Copyright &y& Elsevier]

A 33-year-old patient was hospitalized after a blunt chest trauma with a left flail chest. Six hours after admission to the intensive care unit the patient suddenly developed hypotension and tachycardia. His left chest tube drained 1.5 l of blood within minutes. Immediate resuscitation and emergency sternotomy with left anterolateral extension was performed for pericardial tamponade secondary to left ventricular perforation due to a sharp rib fragment. Outcome was favourable and the patient was operated on for his flail chest by internal stabilization the next day. [Copyright &y& Elsevier]

Objective: Assessment of quality of life (QL) in patients undergoing major surgical procedures is of increasing interest. We focused on surgery of the thoracic aorta requiring deep hypothermic circulatory arrest (DHCA). Aim of this study was to assess QL after thoracic aortic surgery with DHCA, using the Short Form 36 Health Survey (SF-36) questionnaire. Methods: Between 01/94 and 12/99 212 (59.1%) out of a total of 359 interventions on the thoracic aorta were performed under DHCA, with an early mortality of 13.7% (28 patients). During an average follow-up of 3.2±1.3 years, 27 patients died (15.2%) and five patients (2.8%) were lost. A total of 145 patients (81.9%) had a complete follow-up. Results: 125 of the 145 SF-36 questionnaire handed out were answered correctly (86.2%). In relation to a standard population (z=0), the most important deficits were found in physical function (z=−0.53) and role limitations because of physical health (z=−0.42). Good results were found regarding the aspect of pain (z=0.28), social functioning (z=0.02) and vitality (z=−0.02). Overall QL in patients having been operated for aortic aneurysm was better than for patients with acute type A-dissection. Conclusion: Despite restrictions in physical functioning and role limitation because of physical health, QL in patients after interventions on the thoracic aorta with DHCA is fairly good and, for patients being operated for aortic aneurysm, comparable to an age-matched standard population. Patients having being operated electively for aortic aneurysm enjoyed a better QL than patients having been operated emergently for acute type A dissection. [Copyright &y& Elsevier]

Background: In tuberculosis (TB), the risk of exposure is determined mainly by the proximity to and the hours of direct contact with an infectious patient. We describe the contact investigation after detection of an infectious form of TB in a military camp using an Interferon-g-Release-Assay (IGRA, QuantiFERON-TB Gold In Tube [QTF-GIT]) eight weeks after detection of the index case. INDEX PATIENT: The index patient presented with fever, cough and weight loss in the military hospital six weeks after entering the camp. TB was suspected and anti-tuberculous therapy given immediately. Subsequently, TB was microbiologically confirmed., Methods: Four exposure groups were formed a priori based on the proximity and the hours of direct contact to the index case. 168 (95.5%) agreed to be investigated: - Group A: sharing the same dormitory (15 persons) - Group B: same platoon, but not sharing the dormitory (20 persons) - Group C: staff and patients of the military hospital (22 persons) - Group D: other three platoons and senior military staff (111 persons)., Results: 34 (20.2%) out of 168 contacts tested positive in the QFT-GIT assay. For the exposure groups, the respective QFT-GIT testing results were: group A, 14/15 (93%); group B, 4/20 (20%); group C, 5/22 (22.7%); and group D, 11/111 (9.9%). No secondary TB cases were identified., Conclusions: In our study, test results show a correlation with the risk of exposure, suggesting that IGRA may be useful for the assessment of TB infection in TB contacts. The high mobility of recruits reduced traceability of contacts. In this context, QFT-GIT allowed for an efficient screening of contacts at a single time point.

Background and Aim of the Study: Beside aortic valve-sparing surgery, a composite graft, homograft or (more rarely) an autograft are the most common options to replace a diseased or destroyed aortic root in adults. Recently, a new stentless xenograft valved conduit (Shelhigh, No-React) was introduced in Europe. This totally biologic conduit is glutaraldehyde cross-linked, detoxified and heparin-treated with No-React; this process eliminates residual glutaraldehyde and ensures stable tissue cross-linking. The initial clinical and hemodynamic results with this porcine valved conduit in the aortic position are presented herein., Methods: Among 308 patients who underwent thoracic aorta surgery during a 30-month period, 127 had aortic root repair or replacement. The Shelhigh stentless aortic valve conduit was implanted in 35 patients (30 males, 5 females; mean age 68 +/- 7.2 years; mean body mass index 27.5 +/- 4.1 kg/m2). Of these patients, 15 had aortic valve stenosis and ascending aortic aneurysm, 10 had a dilated aortic root with or without aortic regurgitation, four had acute aortic dissection type A, and six had a complex pathology (destructive endocarditis or re-do surgery)., Results: One patient with prosthetic valve endocarditis died on postoperative day 1 from uncontrolled septicemia (30-day mortality, 2.7%). There were no conduit-related adverse events in the surviving patients, but one re-exploration was required for bleeding in a re-do case. Transthoracic echocardiography was available in 30 patients after six months, and in 15 patients after 12 months. The mean gradient across the aortic valve was 8.5 +/- 5.1 mmHg (range: 6 to 14 mmHg for conduit sizes 21 to 29 mm)., Conclusion: The Shelhigh valved conduit shows promising hemodynamic properties. As the conduit contains no fabric or mechanical components, it is ideal for treatment of the infected aortic root, and an excellent alternative to homografts. In older patients, this conduit has the additional advantage that no long-term anticoagulation is required.