Partial left pericardial defect with herniation of the left atrial appendage

Congenital partial pericardial defect confirmed based on spontaneous pneumothorax: A case report and literature review

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Congenital partial pericardial defects are rare but can cause cardiac herniation.

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Pneumopericardium combined with pneumothorax suggests pericardial defect.

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Pneumothorax may worsen the heart protruding through the pericardial defect.

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VATS should be considered in the patients with a pericardial defect.

Introduction

Congenital pericardial defects are rare but can cause fatal complications. Most cases are asymptomatic and incidentally detected during a thoracic surgery or autopsy. We report a case of a partial pericardial defect confirmed based on spontaneous pneumothorax.

Presentation of case

A 16-year-old boy with left spontaneous pneumothorax showed pneumopericardium on chest X-ray. Chest computed tomography revealed a partial pericardial defect. Video-assisted thoracoscopic surgery was performed, and a small pericardial defect was confirmed at the level of the upper pulmonary hilum. We did not reconstruct the defect because of the improbability of cardiac herniation.

Discussion

Pneumopericardium combined with pneumothorax suggests the existence of a pericardial foramen. Partial pericardial defects could cause cardiac herniation or strangulation, and pneumothorax may worsen the protruding of the heart. Video-assisted thoracic surgery is an effective method to prevent the recurrence of pneumothorax and determine whether reconstruction of the defect is required.

Conclusion

Video-assisted thoracic surgery should be performed in the case of a pericardial defect combined with pneumothorax.

Large congenital left atrial wall aneurysm: An updated and comprehensive review of the literature

BACKGROUND

Congenital left atrial wall aneurysms are rare abnormalities that arise from a developmental weakness in the muscular wall. It may be misdiagnosed or go undetected and the delay in diagnosis can lead to catastrophic consequences.

CASE PRESENTATION

An updated and comprehensive review of the literature was performed for all patients with this abnormality under the age of 18. A total of 15 cases including ours are presented in this article. We present a 10-month-old boy who was referred to our center for cardiomegaly. Workup revealed a large atrial wall aneurysm that was successfully corrected with surgery.

CONCLUSION

Historically, left atrial aneurysms were uncommon in the absence of valvular heart disease or other cardiac conditions. Congenital aneurysms are rare phenomenon because they arise without an acquired cardiac disease and surgical correction is crucial for survival.

Congenital aneurysm of the left atrial wall

A congenital aneurysm of the left atrial wall (ALAW) is a rare defect resulting from dysplasia and degeneration of myocardial cells in embryogenesis. We report a case of a 50-year-old female with ALAW, and review 16 previously reported cases and summarize the clinical features, imaging data, and the operations used to treat this rare disease.

Congenital partial defect of the left pericardium presenting as chest pain

Congenital pericardial defect is a rare cardiac defect with variable clinical presentations. It is usually an unexpected finding during cardiac surgery or autopsy. The clinical detection of congenital absence of pericardium is important because of its life-threatening complications such as fatal myocardial strangulation, myocardial ischaemia and sudden death. We present a patient with the incidental finding of left-sided partial defect of the pericardium during evaluation of chest pain.

Paroxysmal atrial fibrillation due to left atrial appendage herniation and review of the literature

The incidence of the isolated form of partial absence of the pericardium is a rare finding. The authors present a case of an isolated left sided pericardial defect with intrathoracic protrusion of the left atrial appendage found during a left upper lobectomy for lung cancer, unrecognized after serial echocardiographs and computed tomography scan of the thorax. The patient suffered from episodes of atrial fibrillation which disappeared after pericardial defect repair without antiarrhythmic medication.

Congenital foramen of the left pericardium

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.

Thoracoscopic closure of a congenital partial pericardial defect

We describe our technique for performing direct thoracoscopic closure of a congenital partial pericardial defect, which was successfully employed in a 15-year-old boy. This is the first such report of a procedure that is noninvasive and may therefore become the treatment of choice for patients with a small congenital pericardial defect.

Diagnosis of congenital pericardial defects, including a pathognomic sign for dangerous apical ventricular herniation, on magnetic resonance imaging

OBJECTIVE

To establish criteria for the accurate diagnosis of different forms of left sided pericardial defects on magnetic resonance imaging. Early detection of a partial apical defect is essential as it is potentially fatal.

DESIGN

Examination of four children with congenital pericardial defects by magnetic resonance imaging, the results being compared with the features on conventional chest radiography and echocardiography and with published data.

RESULTS

Magnetic resonance imaging improved the ability to diagnose and distinguish between complete and partial left sided pericardial defects. A deep myocardial crease was visualised in a patient with apical pericardial defect, indicating the risk of a life threatening ventricular strangulation. A prominent left atrial appendage was, in contrast to many reports, not a reliable sign for partial left sided pericardial defect.

CONCLUSIONS

The various forms of congenital left sided pericardial defects cannot reliably be diagnosed in plain chest radiographs or on echocardiography. Their diagnosis and the distinction between partial and complete defects, however, is of clinical importance and can be accomplished more confidently by magnetic resonance imaging.

Partial congenital defect of the left pericardium: angiographic diagnosis and treatment by thoracoscopic pericardiectomy: case report

Congenital defects of the pericardium are extremely rare and frequently difficult to diagnose. We present a diagnosis of partial congenital defect of the left pericardium based on a characteristic chest X-ray and left ventriculogram. Additionally, we report findings of a diastolic, migratory coronary stenosis on coronary arteriography which, to date, has not been reported. Confirmation of the diagnosis by mediastinoscopy was followed by thoracoscopic pericardiectomy.

Congenital left atrial aneurysms: clinical characteristics and cross-sectional echocardiographic features

Congenital intrapericardial aneurysm of the left atrial wall is a rare anomaly with protean manifestations. Subtle electrocardiographic and chest radiographic abnormalities often give a clue to this disease. This study describes clinical characteristics, cross-sectional and Doppler echocardiographic features of this anomaly in 4 young male patients.

Congenital left atrial wall aneurysm in a patient with neurofibromatosis

A congenital intrapericardial aneurysmal dilatation of the left atrial wall was found in a 28 year old man who presented with atrial fibrillation after a syncopal event. The patient had cutaneous manifestations of neurofibromatosis. The diagnosis was made by cross sectional echocardiography and confirmed by angiocardiography. Surgical excision of the aneurysm resolved the symptoms.

MR diagnosis of herniation of the left ventricle through a pericardial window

The diagnosis of herniation of the left ventricle through a pericardial window was made using MRI. This is a rare type of herniation because it presented 6 years after a pericardial window was made for pericarditis. Herniation of the heart through congenital, traumatic and post surgical pericardial defects are discussed.

Congenital aneurysms of the left atrium: recognition by cross-sectional echocardiography

The two-dimensional echocardiographic features of three patients with congenital aneurysms of the left atrium are described. The aneurysm arose from the left atrial appendage in two patients and from the posterior left atrial wall in one. The aneurysms were characterized by their origin from an otherwise normal left atrium, a well-defined neck, their position within the pericardial space, and distortion of the left ventricular free wall by the aneurysmal body. The differentiation of these structures from other abnormalities of the left atrium are also discussed. Two-dimensional echocardiography is a safe and reliable method for diagnosing congenital aneurysm of the left atrium, and such studies should be considered in any patient with an otherwise unexplained abnormality on the chest radiograph.

Congenital intrapericardial aneurysms of the left atrium

A patient with congenital intrapericardial aneurysm/diverticulum of the left atrium diagnosed preoperatively is described. A review of the 16 previously reported cases revealed that the majority of the patients present with palpitation and are found to have an abnormal cardiac shadow on chest radiography, as did this patient. The aneurysm appears to cause systemic emboli and paroxysmal or persistent atrial tachyarrhythmias which are often resistant to medical therapy. The presence of the aneurysm is suggested by an abnormal contour of the left cardiac border in the postero-anterior chest radiograph and this can be confirmed by angiocardiography. Surgical excision of the aneurysm is indicated in all patients to prevent the occurrence or recurrence of systemic emboli and atrial arrhythmias. Our patient has remained free of symptoms since her operation 14 months ago.