Congenital Pericardial Agenesis Diagnosed at Advanced Age and Treated Via Minimally Invasive Repair

Congenital absence of the pericardium is a rare condition, usually detected incidentally and often asymptomatic. Symptomatic cases are uncommon, and they pose diagnostic and therapeutic challenges.

A 65-year-old man presented with exertional chest discomfort that varied with body position. Transthoracic echocardiography suggested a pericardial defect. Chest computed tomography and cardiac magnetic resonance imaging confirmed complete congenital absence of the pericardium. Thoracoscopic minimally invasive repair without cardiopulmonary bypass or blood transfusion relieved his symptoms.

This case highlights the diagnostic value of multimodal imaging and the feasibility of minimally invasive repair in older patients with symptomatic pericardial agenesis.

Although complete pericardial agenesis is often asymptomatic, surgery may be warranted in symptomatic cases, even in older patients. Thoracoscopic minimally invasive repair without cardiopulmonary bypass or blood transfusion is a feasible approach.