Initial experience with minimally invasive cardiac operations.

Background: Minimally invasive cardiovascular operations have been proposed as an alternative method to correct several cardiac congenital and acquired heart diseases, with the aim to reduce morbidity and mortality.

Objectives: Describe the two years initial experience with minimally invasive operations, with emphasis on technical aspects and the learning curve.

Methods: Between July 2009 and March 2012, 95 patients were operated using minimally invasive operations.

[Severe infection following arteriotomy with Angio-Seal].

Diagnostic or interventional femoral artery catheterizations are more and more commonly practiced, so are haemostatic puncture closure devices, used to prevent bleeding complications and decrease hospital length of stay. Complications, such as infections, have been reported after using haemostatic puncture closure devices. We report the case of a female patient presenting with severe infection after Angio-Seal use: femoral artery infection with sepsis and multiple organ failure, septic embolism with embolic skin abscesses, bacterial arthritis and inferior limb necrosis.

[Metastasis stimulating a myocardial infarction].

A patient with a history of bronchial carcinoma was admitted to the coronary care unit with chest pain suggestive of infarction and an ECG showing changes compatible with acute lateral wall infarction. The coronary arteries were shown to be normal and echocardiography revealed an intracardiac mass which MRI confirmed to be a direct extension of the pulmonary tumour. Echocardiography should be performed systematically in patients with chest pain and ECG changes of ischaemia who also have progressive oncological disease.

[Pulmonary embolism with right intra-auricular thrombus. Fatal outcome during fibrinolysis].

Introduction: The spontaneous prognosis of pulmonary embolism associated with mobile intra-cardiac thrombus is most severe, and the choice of a therapeutic strategy is often difficult.

Observation: The treatment of a patient with intravenous fibrinolytics for massive pulmonary embolism and right atrium thrombus was complicated by his early death. We attributed his death to the migration of the intra-cardiac thrombus.

Should one use echocardiography or contrast transcranial Doppler ultrasound for the detection of a patent foramen ovale after an ischemic cerebrovascular accident?

Patent foramen ovale is frequently associated with embolic cerebrovascular accidents. The diagnosis of patent foramen ovale is easier since the advent of transesophageal echocardiography. However, this method is semi-invasive and is not readily available in all units.