Bartonella endocarditis in a child with tetralogy of Fallot complicated by PR3-ANCA positive serology, autoimmune hemolytic anemia, and acute kidney injury.

Although the role of ANCA in infective endocarditis is unclear, Bartonella henselae has been implicated as the culprit in cases of PR3-ANCA positive subacute bacterial endocarditis (SBE) with glomerulonephritis. In this case, a Coombs-positive autoimmune hemolytic anemia and glomerulonephritis accompanied a PR3-ANCA positive SBE caused by Bartonella henselae.

Correction to: Feasibility and Validity of Printing 3D Heart Models from Rotational Angiography.

The original version of this article unfortunately contained a mistake.

Feasibility and Validity of Printing 3D Heart Models from Rotational Angiography.

Rotational angiography (RA) has proven to be an excellent method for evaluating congenital disease (CHD) in the cardiac cath lab, permitting acquisition of 3D datasets with superior spatial resolution. This technique has not been routinely implemented for 3D printing in CHD. We describe our case series of models printed from RA and validate our technique. All patients with models printed from RA were selected. RA acquisitions from a Toshiba Infinix-I system were postprocessed and printed with a Stratasys Eden 260. Two independent observers measured 5-10 points of interest on both the RA and the 3D model. Bland Altman plot was used to compare the measurements on rotational angiography to the printed model. Models were printed from RA in 5 patients (age 2 months-1 year). Diagnoses included (a) coronary artery aneurysm, (b) Glenn shunt, (c) coarctation of the aorta, (d) tetralogy of Fallot with MAPCAs, and (e) pulmonary artery stenosis. There was no significant measurement difference between RA and the printed model (r = 0.990, p < 0.01, Bland Altman p = 0.987). There was also no significant inter-observer variability. The MAPCAs model was referenced by the surgeon intraoperatively and was accurate. Rotational angiography can generate highly accurate 3D models in congenital heart disease, including in small vascular structures. These models can be extremely useful in patient evaluation and management.

Does loading velocity affect failure strength after tendon repair?

Tensile testing of repaired tendons has been used to assess the efficacy of repair techniques. However, individuals flex and extend fingers at rates higher than those typically used for testing. This study characterized the effect of loading rate on the failure strength of repaired canine flexor tendons. Thirty-six canine flexor digitorum profundus tendons were lacerated, repaired, and tested at three displacement rates: 0.33 mm/s; 84 mm/s; and 590 mm/s. Peak force and stiffness of the repairs were evaluated. Peak force was significantly greater (p<0.05) for tendons distracted at 590 mm/s than at 0.33 mm/s. Crosshead stiffness was significantly greater for tendons distracted at 590 mm/s than at either 84 mm/s or 0.33 mm/s. The predominant failure mode was core suture knot untying. Distracting tendons at slow loading rates provides a conservative assessment of tendon repair strength. Additionally, an estimate of the failure load of this repair for different clinical events has been identified.