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There is a global outbreak of infections due to Mycobacterium chimaera associated with cardiac surgery. The most serious infections involve prosthetic material implantation, and all have followed surgical procedures involving cardiopulmonary bypass. We describe a cluster of four cases following cardiac surgery at a tertiary referral centre in Sydney, Australia. We report novel clinical findings, including haemolysis and kidney rupture possibly related to immune reconstitution inflammatory syndrome. The positive effect of corticosteroids on haemodynamic function in two cases and the failure of currently recommended antimicrobial therapy to sterilise prosthetic valve material in the absence of surgery despite months of treatment are also critically examined. Positron emission tomography was positive in two cases despite normal transoesophageal echocardiograms. The proportion of cases with M. chimaera infection after aortic valve replacement (4/890, 0.45%; 95% confidence interval 0.18–1.15%) was significantly higher than after all other cardiothoracic surgical procedures (0/2433, 0%; 95% confidence interval 0–0.16%).

There are many reports of cardiac abnormalities in athletes. By contrast, there is little known about cardiac abnormalities in Rugby. We observed the ascending aortic index (AoI) of elite rugby players compared to non-elite rugby players.A transthoracic echocardiogram was performed on 162 Rugby players. The AoI was measured and compared.Of the players, 89 were former elite players aged 45 ± 8.4 years, engaged in >5 years of 1st grade Rugby (70% played for their Country/State of Origin). Height was 179.1 ± 11.1 cm and weight 93 ± 17 kg.The remaining 73 played Rugby at club grade >5 years and were well matched for height, weight and age. They were aged 43 ± 6.7 years. Height was 178.2 ± 5.8 cm and weight 92 ± 14.7 kg.In the elite group the AoI was 22 ± 0.6 mm/m 2 . The AoI was enlarged >20 mm/m 2 in 69 players >23 mm/m 2 in 15 players.There was also notable effacement of the anterior sinotubular junction in 65% of the elite players.In the non-elite players the average AoI was smaller at 18.1 ± 0.8 mm/m 2 . The AoI was enlarged >20 mm/m 2 in 8 players >23 mm/m 2 in one player.The incidence of AoI 20 mm/m 2 in elite Rugby players is significantly greater than a matched non elite population (p < 0.0001). The reason for this is unknown; it could be secondary to the training regime, the high aortic pressures developed during strength training in conjunction with explosive aerobic exercise, thoracic micro trauma, or the unique game playing tactics and tackling. It is unlikely to be an expression of a pathological condition but may have longer term clinical implications. http://dx.

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