The abnormal left hilum

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.

Jugular phlebogram in congenital absence of the pericardium

The purpose of this study was to emphasize the diagnostic value of the jugular phlebogram in congenital absence of the pericardium. Phonocardiographic study was performed in seven patients with complete absence of the left pericardium and in four with partial pericardial defect (left sided in three, right sided in one). Associated heart lesions were absent in all patients. The characteristic features of the jugular phlebogram in these patients were decreased depth of x descent and tall v wave followed by deep y descent (M-shaped pattern). These jugular abnormalities were more prominent in complete absence of the left pericardium than in partial pericardial defect. The x descent was completely obliterated in two patients with complete left pericardial defect. Loss of decrease in pericardial pressure during ventricular ejection and altered cardiac position as a result of the absence of the pericardium may be responsible for these jugular abnormalities. Jugular venous M-shaped pattern may be one of the useful physical and phonocardiographic indicators for the diagnosis of congenital absence of the pericardium.