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Coronary artery disease in a patient with a congenital pericardial defect
A Amiri1, C Weber, V Schlosser
1Department of Cardiovascular Surgery, University of Freiburg, FRG.
Insights
A rare congenital pericardial defect caused a 43-year-old male's heart to herniate, leading to coronary artery disease. Surgical intervention revealed strangulation and stenosis correlating with the defect.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Case Reports
Background:
- Congenital pericardial defects are rare anomalies.
- Coronary artery disease (CAD) typically presents with known risk factors.
Observation:
- A 43-year-old male presented with a congenital pericardial defect affecting the left ventricle.
- The patient had undiagnosed 2-vessel CAD without typical risk factors.
Findings:
- Intraoperative findings revealed cardiac herniation into the left pleural cavity.
- Strangulation by the pericardium caused bridle strictures and ventricular narrowing.
- Stenosis in the right coronary artery (RCA) and left anterior descending (LAD) artery precisely corresponded to these stricture areas.
Implications:
- This case highlights a unique presentation of congenital pericardial defect causing secondary coronary artery disease.
- It underscores the importance of considering anatomical anomalies in unexplained cardiac conditions.
- Surgical findings provided direct correlation between pericardial defect, cardiac malposition, and coronary artery stenosis.
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.