Congenital partial absence of the pericardium with herniation of the left atrial appendage

Congenital complete absence of left pericardium Report of two cases

“…In partial defects this diagnosis has also been confirmed by angiocardiography (Hering et al, 1960;Kavanagh-Gray, Musgrove, and Stanwood, 1961 ;Tucker et al, 1963). However, this is of no value in total absence of the pericardium or in those partial defects where a portion of heart has not herniated through the defect.…”

“…This is particularly so when the defect is partial (Ellis et al, 1959;Hering, Wilson, and Ball, 1960;Tucker, Miller, and Jacoby, 1963).…”

“…While Tucker et al (1963) and Hering et al (1960) performed the technically easy pericardiotomy, in general, closure of the defect is preferable, for not only does it prevent cardiac herniation but it also prevents spread of any later pleural infection into the pericardial cavity.…”

Congenital pericardial defects

“…Southworth and Stevenson (1938) reviewed all the previously reported cases of congenital pericardial defects and found that complete absence of the left pericardium accounted for 76% of these cases. However, recently partial defects are being reported more frequently (Rusby and Sellors, 1945;Fry, 1953;Jones, 1955;Dimond, Kittle, and Voth, 1960;Hering, Wilson, and Ball, 1960;Chang and Leigh, 1961;Kavanagh-Gray, Musgrove, and Stanwood, 1962;Bruning, 1962;Duffle, Moss, and Maloney, 1962;Tucker, Miller, and Jacoby, 1963;Williams, 1963;Hipona and Crummy, 1964;Mukerjee, 1964;Baker, Schlang, and Ballenger, 1965). This is probably explained by the fact that most of the earlier cases were recognized at necropsy, and it would be easier to miss a partial defect, especially when small, during routine post-mortem examination.…”

“…Carleton (1929) showed that removal of the pericardium in cats produced permanent enlargement of the cardiac shadow, which he thought was due to dilatation and not hypertrophy. In one of the patients reported by Tucker et al (1963), wide splitting of the left pericardium resulted in 'definite enlargement of the heart shadow'. Kuno (1915) found that removal of the pericardium in the heart-lung preparation tended to produce cardiac dilatation and lower filling pressure.…”