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Shingu M, Matsumoto K, Yamazaki T, Kawasaki S, Nishisaki H. 'Le plus important est invisible': congenital pericardial defect with structural, electrophysiological, and haemodynamic alterations induced by postural changes-a case report. Eur Heart J Case Rep 2025; 9:ytaf200. [PMID: 40336934 PMCID: PMC12056940 DOI: 10.1093/ehjcr/ytaf200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 02/22/2025] [Accepted: 04/15/2025] [Indexed: 05/09/2025]
Abstract
Background The principal roles of the pericardium include protection from microorganisms, prevention of cardiac friction, and restriction of unlimited dilation of the heart. In the case of a congenital pericardial defect in which structural, electrophysiological, and haemodynamic abnormalities manifested during postural changes, we propose another indispensable pericardial function of cardiac central anchorage. Case summary A 29-year-old man with atypical chest pain was referred to our hospital. Electrocardiography revealed fluctuations in the QRS transitional zone, electrical axis, and atrial polarity with body posture. Echocardiography revealed a far dorsally displaced heart, paradoxical motion of the interventricular septum (IVS), and hyperdynamic motion of the posterior wall in the left lateral decubitus position, which normalized to the right lateral decubitus position, along with significant haemodynamic alterations. Multidetector-row computed tomography revealed a complete absence of the left pericardium. Discussion When pericardial fixation is impaired, the heart falls dorsally owing to gravity in the left lateral decubitus position, resulting in right ventricular overstretch and enlargement, which, in turn, results in compression of the left ventricle via a leftward shift of the IVS and a consequent reduction in cardiac output. Moreover, the energy generated by the myocardium, which should normally be concentrated only on blood ejection, would be distributed between the energy used for ejection and that used for the leap-up movement of the heart, reducing its energy efficiency. Through detailed observation of the congenital pericardial defect, haemodynamic insights into the important functions of the pericardium, which were not visible through static observation, were obtained.
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Affiliation(s)
- Manami Shingu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Isou, Hikami-cho, Tamba-shi, Hyogo, Tamba 669-3495, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Isou, Hikami-cho, Tamba-shi, Hyogo, Tamba 669-3495, Japan
| | - Tetsu Yamazaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Isou, Hikami-cho, Tamba-shi, Hyogo, Tamba 669-3495, Japan
| | - Satoru Kawasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Isou, Hikami-cho, Tamba-shi, Hyogo, Tamba 669-3495, Japan
| | - Hogara Nishisaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Isou, Hikami-cho, Tamba-shi, Hyogo, Tamba 669-3495, Japan
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Alyami B, Alharbi A, Alhajji M, Gendi S, Hamirani YS. A case report of congenital absence of the pericardium that was diagnosed by cardiac computed tomography angiogram (CCTA). Radiol Case Rep 2022; 17:3380-3384. [PMID: 35874871 PMCID: PMC9304677 DOI: 10.1016/j.radcr.2022.06.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
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de Almeida Prado PS, Fernandes LC, Tavares R. Unexpected death in a newborn due to a congenital partial pericardial defect: a case report. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pericardial defects are rare anatomical variations that can present as an isolated variation or be associated with other conditions. They are usually asymptomatic and misdiagnosed conditions, and given their rarity, partial pericardial defects can have devastating outcomes. The sudden death of an apparently healthy newborn certainly raises concerns, and a medico-legal investigation is crucial in establishing the cause of death. This case report highlights the importance of awareness on the part of obstetric professionals of the lethal outcomes of pericardial partial congenital defects. This case also demonstrates the difficulty of establishing a correct diagnosis.
Case presentation
The autopsy of a 15-h-old neonate revealed a partial pericardial defect ending in a biventricular strangulation by the defective pericardium. Other findings, such as the patency of the arterial ductus, a subarachnoid hemorrhage, and aspiration of amniotic fluid, were also reported.
Conclusions
Although imaging techniques have evolved, fetal detection of cardiac abnormalities can be tricky, especially when occurring as an isolated variation.
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Zhu X, Zhang L, Tang Z, Xing FB, Gao X, Chen WB. Mature mediastinal bronchogenic cyst with left pericardial defect: A case report. World J Clin Cases 2021; 9:11362-11368. [PMID: 35071567 PMCID: PMC8717515 DOI: 10.12998/wjcc.v9.i36.11362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/26/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mediastinal bronchogenic cysts and pericardial defects are both rare. It is extremely rare that both occur simultaneously. To the best of our knowledge, this is the first case of a coexistent bronchogenic cyst and pericardial defect reported in China. We performed a literature review and found a relationship between bronchogenic cysts and pericardial defects, which further revealed the correlation between the bronchus and pericardium during embryonic development.
CASE SUMMARY A 14-year-old boy attended a local hospital for ankylosing spondylitis. Chest radiography showed an enhanced circular-density shadow near the left mediastinum. The patient had no chest symptoms and the physical examination was normal. Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment. During surgery, a left pericardial defect was observed. The bronchogenic cyst was removed by thoracoscopic surgery, but the pericardial defect remained untreated, and a satisfactory outcome was achieved after the operation. The patient was diagnosed with a mediastinal tumor. The pathological diagnosis of the tumor was a bronchogenic cyst.
CONCLUSION This case further reveals the correlation between the bronchus and pericardium during embryonic development.
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Affiliation(s)
- Xiao Zhu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Lei Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Zhen Tang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Fu-Bao Xing
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Xiong Gao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Wen-Bang Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
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Cho H, Kang EJ, Kim MS, Jeong S, Lee KN. Incidentally Detected Pericardial Defect in a Patient with Pneumothorax as Confirmed on Video-Assisted Thoracoscopic Surgery. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:749-755. [PMID: 36238774 PMCID: PMC9432441 DOI: 10.3348/jksr.2020.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022]
Abstract
Congenital defects of the pericardium, which are generally asymptomatic, are rare disorders characterized by complete or partial absence of the pericardium. Here, we report a rare case of a 19-year-old male who was incidentally diagnosed with congenital absence of the left pericardium during examination for symptoms of pneumothorax. Chest radiography and computed tomography revealed a collapsed left lung without any evidence of trauma, no unusual findings of free air spaces along the right side of the ascending aorta, heart shifted toward the left side of the thorax, and a shallow chest. Subsequent thoracoscopy confirmed the absence of the left pericardium and displacement of the heart toward the left thoracic cavity. We further discuss the correlation between radiologic images and surgical findings of a congenital pericardial defect associated with spontaneous pneumothorax.
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Affiliation(s)
- Hyunwoo Cho
- Department of Radiology, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Ju Kang
- Department of Radiology, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Moon Sung Kim
- Department of Radiology, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Sangseok Jeong
- Department of Cardiothoracic Surgery, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Ki-Nam Lee
- Department of Radiology, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
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Bouchard M, Hoschtitzky A, Gatzoulis M. Diagnosis and management of congenital absence of pericardium: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 3:1-5. [PMID: 31911998 PMCID: PMC6939816 DOI: 10.1093/ehjcr/ytz223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/19/2022]
Abstract
Background Absence of the pericardium is a rare congenital defect with an approximate incidence of <1/10 000. We review a case of complete pericardial agenesis in a symptomatic patient with gross cardiac mobility, for which pericardial reconstruction was undertaken successfully. Case summary A 24-year-old otherwise fit and well patient, with debilitating exertional chest pain was found to have complete pericardial agenesis on the left side and on the diaphragmatic surface. There was gross cardiac mobility demonstrated on cardiac magnetic resonance imaging. His pericardium was reconstructed surgically using Gore-tex® patches. There were no complications, and the patient was discharged 8 days later. Three months later at follow-up, the patient required no analgesia and has had complete resolution of his chest pains. Discussion Congenital hemi-pericardial agenesis is a very rare condition which often remains undetected due to its asymptomatic nature. It is important to consider this as a differential diagnosis of exertional chest pains. Cardiac magnetic resonance imaging remains the investigation of gold standard. There is no consensus on whether surgical intervention in symptomatic or asymptomatic patients has any prognostic value. However, we have demonstrated that by reconstructing the pericardium in a highly symptomatic patient, there has been a resolution in size of a previously dilated right ventricle and most importantly an improvement in quality of life.
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Affiliation(s)
- Melissa Bouchard
- Department of Adult Congenital Heart Disease and Surgery, The Royal Brompton Hospital, Sydney Street, Chelsea, London SW3 6NP, UK
| | - A Hoschtitzky
- Department of Adult Congenital Heart Disease and Surgery, The Royal Brompton Hospital, Sydney Street, Chelsea, London SW3 6NP, UK
| | - M Gatzoulis
- Department of Adult Congenital Heart Disease and Surgery, The Royal Brompton Hospital, Sydney Street, Chelsea, London SW3 6NP, UK
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Nishimoto K, Umegaki T, Ohira S, Nakajima Y, Soeda T, Kamibayashi T. Relief of cardiac tamponade by a congenital partial left-sided pericardial defect in a patient with ruptured acute type A aortic dissection: a case report. JA Clin Rep 2019; 5:4. [PMID: 32026974 PMCID: PMC6967064 DOI: 10.1186/s40981-019-0223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/03/2019] [Indexed: 12/03/2022] Open
Abstract
Background Acute type A aortic dissections have an extremely poor prognosis, and cardiac tamponade is a major cause of death in these patients. Here, we describe a case where congenital partial pericardial defect relieved cardiac tamponade caused by ruptured type A aortic dissection. Case presentation A 79-year-old woman was hospitalized after experiencing chest pains and respiratory distress. She developed out-of-hospital cardiopulmonary arrest and was resuscitated with no sequelae 5 days before admission. Computed tomography confirmed pericardial and left pleural effusions, and type A aortic dissection was diagnosed. We began emergency ascending aortic replacement surgery under general anesthesia with propofol and remifentanil and incidentally discovered a congenital partial left-sided pericardial defect that allowed drainage of the hemopericardium and relieved cardiac tamponade. The surgery was successfully performed, and the patient recovered without complications. Conclusions We experienced an extremely rare case where a congenital partial pericardial defect relieved cardiac tamponade associated with aortic dissection and contributed to the patient’s survival.
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Affiliation(s)
- Kota Nishimoto
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takeshi Umegaki
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
| | - Sayaka Ohira
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Yurina Nakajima
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takehiro Soeda
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takahiko Kamibayashi
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
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Abstract
Although the pericardium is simply a 2-layered membrane enveloping the heart and great vessels, there are numerous anatomic variations, congenital anomalies, and pathologic conditions that can occur. Although echocardiography is most often the first imaging modality used to assess the pericardium, computed tomography and MR imaging are frequently being used to aid in diagnosis and assess response to therapy. Therefore, detailed knowledge of the pericardium in both its normal and diseased states is important to best direct patient care and potentially improve patient outcomes.
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Affiliation(s)
- Seth Kligerman
- Diagnostic Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA.
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Schneider AM, Manning BM, Bolton WD. Rare Cause of Pneumopericardium in a Patient following a Motor Vehicle Collision. Am Surg 2017. [DOI: 10.1177/000313481708300814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Benjamin M. Manning
- Department of Trauma and Critical Care Greenville Health System Greenville, South Carolina
| | - William D. Bolton
- Department of Thoracic Surgery Greenville Health System Greenville, South Carolina
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10
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Shah AB, Kronzon I. Congenital defects of the pericardium: a review. Eur Heart J Cardiovasc Imaging 2015; 16:821-7. [PMID: 26003149 DOI: 10.1093/ehjci/jev119] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/15/2015] [Indexed: 12/15/2022] Open
Abstract
Pericardial defects are a rare disorder that can be characterized as acquired or congenital. Congenital defects can be further characterized by location and size of the defect, e.g. left- or right-sided and partial or complete absence of the pericardium. While physical examination and electrocardiogram are not diagnostic, chest radiographs and echocardiography have findings that should alert the clinician to the absence of the pericardium as a possible diagnosis. Despite its limitations with visualizing the normal pericardium in areas of minimal adipose, cardiac magnetic resonance is currently the gold standard for diagnosing the congenital absence of the pericardium. Patients have a similar life expectancy to those without pericardial defects; however in certain cases, herniation and strangulation of cardiac chambers can be life threatening and lead to sudden cardiac death. Treatment is tailored to the patient's symptoms, presentation, and the size and location of the defect.
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Affiliation(s)
- Ankit B Shah
- Lenox Hill Hospital, 100 East 77th Street, 2nd Floor Non-invasive Cardiology, New York, NY 10075, USA
| | - Itzhak Kronzon
- Lenox Hill Hospital, 100 East 77th Street, 2nd Floor Non-invasive Cardiology, New York, NY 10075, USA
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11
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Hiraoka K, Yamazaki S, Hosokawa M, Suzuki Y. Bronchogenic cyst associated with congenital absence of the pericardium. J Surg Case Rep 2015; 2015:rjv052. [PMID: 25907540 PMCID: PMC4407419 DOI: 10.1093/jscr/rjv052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We report a rare case of bronchogenic cyst associated with congenital complete absence of the pericardium. A 17-year-old male was admitted to the hospital for surgical resection of a growing cystic lesion located in the middle mediastinum. The patient was asymptomatic and no significant findings were found on physical examination. Resection of the mediastinal cyst was performed by video-assisted thoracoscopic surgery. The complete absence of the pericardium was immediately observed along with a cystic tumor arising from the mediastinum. After the resection of the cyst, no additional procedure to reconstruct the absence of the left pericardium was performed. Pathological diagnosis was a bronchogenic cyst. Congenital absence of the pericardium may be associated with the bronchogenic cyst and complete absence of the pericardium requires no additional surgical reconstruction, if remaining space in the pleural cavity is small enough to avoid cardiac disposition after surgical resection of the cyst.
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Affiliation(s)
- Kei Hiraoka
- Department of Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Shigeo Yamazaki
- Department of Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Masao Hosokawa
- Department of Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Yasuhiro Suzuki
- Department of Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
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12
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Abstract
Congenital foramen of the left parietal pericardium is uncommon. The condition has the potential to cause angina pectoris, myocardial infarction, or even death. Forty-three confirmed cases have been retrieved from the English language literature, and a case report of "life-threatening" herniation of the heart is here added. The diagnosis, made at a mean age of 20 years (range 2 to 48), was five times more common in men. In 5 fatal cases, the heart had become incarcerated. In the remainder of cases, one-third were asymptomatic, and two-thirds suffered a chest complaint that prompted diagnosis. Chest discomfort, dyspnea, and syncope were the most common symptoms. The most common finding at surgery, which 34 patients underwent, was a foramen at the base of the heart through which the left atrial appendage had herniated. In eight instances, the rim of the defect lay upon and compressed the coronary circulation. Measures to remedy the disorder have included a variety of operations, some to enlarge the defect, others to close it, amputation of the atrial appendage, and, in two cases, myocardial revascularization. Surgery is appropriate in the majority of symptomatic patients and in all who are at risk for ventricular herniation.
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Affiliation(s)
- K R Bennett
- Department of Medicine, University of Mississippi School of Medicine, Jackson 39216, USA.
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13
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Auch-Schwelk W, Bonzel T, Krause T, Kroepelin T, Wimmer B, Schlosser V, Just H. Differential diagnosis of chest pain and diagnostic findings in pericardial defects combined with coronary artery disease. Clin Cardiol 1988; 11:650-7. [PMID: 3229021 DOI: 10.1002/clc.4960110912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- W Auch-Schwelk
- Department of Cardiology, University of Freiburg, Federal Republic of Germany
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Nicolosi GL, Borgioni L, Alberti E, Burelli C, Maffesanti M, Marino P, Slavich G, Zanuttini D. M-mode and two-dimensional echocardiography in congenital absence of the pericardium. Chest 1982; 81:610-3. [PMID: 7075282 DOI: 10.1378/chest.81.5.610] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The M-mode and two-dimensional echocardiographic features of congenital absence of the pericardium are described in two cases that had been confirmed by clinical and radiological data. The M-mode echocardiogram showed right ventricular dilatation and abnormal systolic motion of the interventricular septum. Echo contrast studies with peripheral injection of saline solution revealed normal persistence of microbubbles in the right side of the heart. Two-dimensional short axis parasternal views showed some dilatation of the right ventricle, with anterior displacement of the left ventricular cavity in systole, which appeared to be wider than the posterior motion of the interventricular septum towards the posterior wall. The resulting positive motion of the interventricular septum toward the transducer could account for the abnormal pattern seen in the M-mode echocardiogram. Congenital absence of the left pericardium has particular echocardiographic features not diagnostic for the anomaly. However, the M-mode and two-dimensional echocardiographic studies, used in conjunction with the echocontrast techniques, seem to help in the differential diagnosis and for excluding associated anomalies.
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15
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Inoue H, Fujii J, Mashima S, Murao S. Pseudo right atrial overloading pattern in complete defect of the left pericardium. J Electrocardiol 1981; 14:413-8. [PMID: 7299313 DOI: 10.1016/s0022-0736(81)81016-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Two cases with complete defect of the left pericardium showing tall and peaked P waves in the right precordial leads are described. A review of the literature has yielded nine cases with uncomplicated complete defect of the left pericardium showing similar P wave changes. Right heart catheterization, performed in nine cases, including the present two cases, revealed no evidence of an intracardiac shunt in any case and normal intracardiac pressure in eight cases. Therefore, this P wave changes seems to be related to intrathoracic shift in cardiac position permitted by the absence of the restraining pericardium.
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16
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Inoue H, Mashima S, Takayanagi K, Murayama M, Matsuo H, Sakamoto T, Murao S. Postural changes of vectorcardiogram in defect of the left pericardium. J Electrocardiol 1981; 14:21-4. [PMID: 7205112 DOI: 10.1016/s0022-0736(81)80024-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Effects of postural changes upon the vectorcardiograms (VCGs) of four cases with a defect of the left pericardium (three complete and one partial) were compared to those of 115 control cases. Changes in the direction of a given instantaneous vector brought about by postural changes were significantly larger in cases with a pericardial defect than in controls. By turning to the left lateral position, the magnitude of the maximum leftward force decreased in all cases with complete defect, and increased in the case with partial defect and in 96% of controls. These findings were considered to reflect the increased mobility of the heart in cases with pericardial defect due to the lack of the restraining function of the pericardium.
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17
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Quiste broncogenico y agenesia del pericardio. Arch Bronconeumol 1978. [DOI: 10.1016/s0300-2896(15)32616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Payvandi MN, Kerber RE. Echocardiography in congenital and acquired absence of the pericardium. An echocardiographic mimic of right ventricular volume overload. Circulation 1976; 53:86-92. [PMID: 127675 DOI: 10.1161/01.cir.53.1.86] [Citation(s) in RCA: 83] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to investigate the echocardiographic effects of absence of the pericardium. Five patients with congenital complete absence of the left pericardium were studied. All had typical chest X-rays, four had cardiac catheterization which excluded any intracardiac shunts, and one had diagnostic pneumothorax. All five had an enlarged right ventricular dimension (RVD): 1.9 +/- 0.1 cm/m2 (normal: less than 1.3 cm/m2) and abnormal interventricular septal (IVS) motion (three Type A, two Type B). Sixteen additional patients were studied after pericardial stripping for a variety of conditions. In none was cardiopulmonary bypass used. Eight of these patients had preoperative echocardiograms; all showed normal IVS motion. After surgery RVD was large in all 16 patients, increasing from 1.0 +/- 0.2 cm/m2 preoperatively to 1.7 +/- 0.1 cm/m2 postoperatively, P less than 0.01. Fourteen of the 16 patients had abnormal IVS motion, nine Type A, and five Type B. We conclude that absence of the pericardium results in echocardiographic abnormalities which mimic those seen in right ventricular volume overload. This may be due to altered cardiac position and motion within the thorax resulting from loss of normal pericardial restraint.
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Abstract
A case of herniation of the left atrial appendage, through a defect in the pericardium, is described in a 16-year-old boy who was below the third percentile for height and weight. The clinical presentation was an acute pericarditis. Widespread inversion of T waves on the electrocardiogram and collapse of the lower lobe of the left lung with pleural effusion developed. Thoracotomy showed strangulation of the atrial appendage which was excised, and the pericardial defect repaired. After operation there was a striking improvement in the electrocardiogram and a rapid gain in weight. Syndromes caused by pericardial defects are reviewed.
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22
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Moene RJ, Dekker A, van der Harten HJ. Congenital right-sided pericardial defect with herniation of part of the lung into the pericardial cavity. Am J Cardiol 1973; 31:519-22. [PMID: 4692589 DOI: 10.1016/0002-9149(73)90305-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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23
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Pernot C, Hoeffel JC, Henry M, Frisch R, Brauer B. Partial left pericardial defect with herniation of the left atrial appendage. Thorax 1972; 27:246-50. [PMID: 5034603 PMCID: PMC472534 DOI: 10.1136/thx.27.2.246] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A case is reported of herniation of the left atrial appendage through a partial pericardial defect, probably congenital. The diagnosis was suggested by the history of chest pain and bulging of the middle segment of the left heart border on the plain chest film, without other signs. Angiography revealed a dilated left atrial appendage. An artificial left pneumothorax confirmed the presence of a pleuropericardial defect. The surgical procedure included excision of the appendage and closure of the defect.
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Deutsch AA, Brown KN, Freeman NV, Stanley DA. A case of diaphragmatic hernia, absent pericardium, and hamartoma of liver. Br J Surg 1972; 59:156-8. [PMID: 4679627 DOI: 10.1002/bjs.1800590223] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Abstract
A case is described of a diaphragmatic hernia associated with a left pericardial defect and hamartoma of the liver. The possible embryological origin of the first two defects from premature closure of the duct of Cuvier is discussed. The radiographic changes of the absent pericardium are mentioned and the histology of the liver hamartoma is described.
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Heikkilä J, Luomanmäki K, Karhunen P. Isolated pericardial rupture after blunt chest injury. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1971; 5:159-62. [PMID: 4255888 DOI: 10.3109/14017437109135549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Five cases of herniation of the heart are described, of varying aetiology and presentation. In one, the pericardial deficiency is congenital. Two are traumatic—one with severe disruption of the rib cage, and one without. Two are post-operative—one early, and one late. Their aetiology, diagnosis and treatment are discussed. If the possibility of herniation is considered, the diagnosis may often be made from a plain chest radiograph. The treatment is operative, and may give relief from a critical circulatory embarrassment.
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Lajos TZ, Bunnell IL, Colokathis BP, Schimert G. Coronary artery insufficiency secondary to congenital pericardial defect. Chest 1970; 58:73-6. [PMID: 5425306 DOI: 10.1378/chest.58.1.73] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Jiménez Martínez M, Franco Vázquez JS, Gutíerrez Bosque R, Pérez Alvarez JJ, Argüero Sánchez R. Cor triatriatum with pericardial agenesis. Thorax 1969; 24:667-72. [PMID: 5350716 PMCID: PMC472070 DOI: 10.1136/thx.24.6.667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
A case of cor triatriatum associated with pericardial agenesis, which was successfully treated, is reported. Details of the clinical picture and surgical treatment are given, with emphasis on the good prognosis which results when the diagnosis is made before attempting surgical correction.
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