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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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Khayata M, Haouzi AA, Asher CR, Xu B. Multimodality Imaging Approach Evaluation of the Congenital Pericardial Defect: a Contemporary Review. Curr Cardiol Rep 2023; 25:1715-1724. [PMID: 38060098 DOI: 10.1007/s11886-023-02004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW This review presents the etiology, clinical manifestations, diagnostic approach, and treatment of congenital pericardial defects. It also highlights the critical role of echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR) in the diagnosis and management approach. RECENT FINDINGS Congenital pericardial defects are rare. Although most cases are found incidentally, some cases could potentially be associated with serious outcomes including sudden cardiac death. The diagnosis is often challenging due to non-specific clinical manifestations and electrocardiogram findings. Echocardiography is the first-line imaging investigation for the evaluation of this condition. Advanced cardiac imaging modalities, including CCT and CMR, play important adjuvant roles in establishing the diagnosis and assists with prognostication.
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Affiliation(s)
- Mohamed Khayata
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Alice A Haouzi
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Craig R Asher
- Section of Cardiovascular Medicine, Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
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Rayamajhi S, Shrestha R, Shahi K, Adhikari B, Mahaseth A. Congenital Pericardial Agenesis presenting as non-specific chest pain: A Case Report. Radiol Case Rep 2022; 17:4462-4465. [PMID: 36311874 PMCID: PMC9597428 DOI: 10.1016/j.radcr.2022.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022] Open
Abstract
Congenital absence of pericardium is an exceedingly rare condition with a prevalence of 0.002%-0.004%. Due to its rarity and absence of association with any specific clinical examination finding, the diagnosis may be challenging. Due to the absence of symptoms and clinical awareness, pericardial agenesis is commonly misdiagnosed. It is important to consider this as a differential diagnosis of exertional chest pains. We report the case of a 9-year-old boy who attended our institution for non-specific but frequent symptoms and was diagnosed with congenital complete absence of the pericardium. The rarity of the condition can hinder timely diagnosis, as a physician or radiologist may never encounter a single case in their lifetime.
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Affiliation(s)
- Sushil Rayamajhi
- Department of Internal Medicine/Radiology, Swacon International Hospital, Battisputali, Kathmandu, Nepal
- Corresponding author.
| | - Rekha Shrestha
- Department of Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Kopila Shahi
- Department of Medicine, ZH Sikder Women's Medical College, Dhaka, Bangladesh
| | - Bibek Adhikari
- Department of Internal Medicine, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
| | - Aditya Mahaseth
- Department of Cardiology, Shahid Gangalal National Heart Center, Janakpur, Nepal
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Scagliola R, Seitun S, Rosa GM. Cardiac herniation: A practical review in the emergency setting. Am J Emerg Med 2022; 53:222-227. [DOI: 10.1016/j.ajem.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
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Khayata M, Alkharabsheh S, Shah NP, Verma BR, Gentry JL, Summers M, Xu B, Asher C, Klein AL. Case series, contemporary review and imaging guided diagnostic and management approach of congenital pericardial defects. Open Heart 2020; 7:e001103. [PMID: 32076559 PMCID: PMC6999674 DOI: 10.1136/openhrt-2019-001103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/07/2019] [Accepted: 12/12/2019] [Indexed: 01/20/2023] Open
Abstract
Objective Congenital pericardial defect (CPD) is a rare entity with an estimated frequency of 0.01%–0.04%. The recognition of this anomaly is important since it can be associated with serious complications. The aim of this study and review was to describe clinical and imaging features that help in establishing the diagnosis of this condition. Methods We retrospectively reviewed all adult patients at the Cleveland Clinic Health System with the diagnosis of CPD between the years 2000 and 2015. Baseline clinical characteristics, clinical manifestations, ECG, transthoracic echocardiography (TTE), cardiac CT and cardiac magnetic resonance (CMR) images were reviewed. Results Eight patients were included in the study. Sixty-three percent of patients were males with mean age at diagnosis of 48 years, 63% had a partial pericardial defect on the left side and right ventricular (RV) dilation on TTE. Three patients had CMR. Levocardia was present in all CMRs. One patient had greater than 60° clockwise rotation and none of the CMRs showed ballooning of the left ventricular apex. One patient required surgical pericardioplasty. The remaining seven patients had a median follow-up of 17.3 months (5–144.9 months) and all remained asymptomatic. Conclusion CPDs are more likely to be partial on the left side and patients often have RV dilation on the TTE and levocardia on CMR. Most patients remain stable and do not require surgical intervention. TTE and CMR play an important role in making the diagnosis of this anomaly.
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Affiliation(s)
| | | | | | - Beni Rai Verma
- Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Bo Xu
- Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Craig Asher
- Cardiology, Cleveland Clinic Florida, Weston, Florida, USA
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Congenital Partial Absence of Pericardium: A Mimic of Arrhythmogenic Right Ventricular Cardiomyopathy. Case Rep Med 2018; 2018:4297280. [PMID: 29849659 PMCID: PMC5914131 DOI: 10.1155/2018/4297280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/20/2018] [Indexed: 12/17/2022] Open
Abstract
Congenital absence of pericardium is a rare condition with electrocardiogram, chest X-ray, and echocardiographic findings which may mimic those of other cardiac conditions. We present a case of a 19-year-old asymptomatic female with incidental cardiomegaly on chest X-ray and electrocardiographic and echocardiographic changes, which meet the revised task force criteria for definite arrhythmogenic right ventricular cardiomyopathy but subsequently confirmed to have congenital partial absence of pericardium on cardiac magnetic resonance imaging.
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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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