Coronary Artery Disease in a Patient with a Congenital Pericardial Defect

Abstract

This case report summarizes our experience with a 43 year old male patient with congenital pericardial defect, involving the left ventricular part of the pericardium, and additionally 2-vessel coronary-artery disease in the absence of any coronary risk factors. This patient underwent coronary-artery bypass grafting. Intraoperatively the heart was found to be rotated and herniated into the left pleural cavity, strangulated by the remaining pericardium causing a bridle stricture of the right as well as the left margin of the heart, with a subsequent local narrowing of the ventricle in these areas. Furthermore, assessment of the coronary arteries at operation by external palpation showed the location of an RCA- and LAD-stenosis to match exactly with the stricture area.

Congenital Absence of Pericardium: A Case Report and Technical Considerations in Cardiac Surgery

“…The absent pericardium can potentially cause difficulty in LIMA harvesting due to obstruction to view by the higher position of the phrenic nerve. The unusual rotation of the heart, with a posterior-facing apex, may further complicate the procedure [ 4 ]. However, the access to the right and left atria may be easier and assist with exposure during mitral or tricuspid valve surgery.…”

“…In the surgical context, particularly in procedures such as coronary artery bypass grafting (CABG), CPA presents unique challenges. The absence of the pericardium can significantly impact the heart's orientation and stability during heart surgery, necessitating modifications in surgical techniques and perioperative management [3,4]. Previous case reports and studies have highlighted the complexities of managing CPA and underlined the importance of intraoperative adaptability to address the atypical cardiac positioning and movement during surgery, primarily in the context of off-pump surgery, where pericardial stays are necessary to position the heart [5][6][7].…”

A Case of Partial Congenital Pericardial Defect Presenting as Acute Coronary Syndrome

“…However some patients experience syncope, arrhythmia, and chest pain. The most prevalent symptom is angina-like chest pain that can also appear after postural changes 3)4). The exact mechanism of the chest pain is unclear.…”

Congenital complete absence of pericardium presenting with chest pain: MRI characteristics

“…Complete absence of the pericardium usually carries an excellent prognosis and has only been rarely associated with traumatic transection of aorta, type A aortic dissection, sudden death due to possible torsion/trauma to great vessels owing to cardiac hypermobility [1,6,8]. Partial defects have been much more frequently associated with life threatening complications that include herniation and strangulation of a heart chamber or stenosis of a coronary artery leading to dysrhythmias, angina and sudden cardiac death [1,9].…”