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(Circulation. 1998;97:1992.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Partial Pericardial Defect

Kean-Wah Lau, MBBS, M Med; ; Zee-Pin Ding, MBBS, M Med

From Singapore Heart Centre, Singapore General Hospital.

Correspondence to Kean-Wah Lau, MBBS, M Med, FACC, Consultant Cardiologist, Singapore Heart Centre, 3rd Hospital Ave, Singapore 169608.

A 49-year-old healthy-looking man presented with vague chest discomfort in September 1995. Physical examination was unremarkable. Echocardiography revealed mild mitral valve prolapse and an incomplete pericardial echo, arousing suspicion of a partial pericardial defect. A subsequent CT scan of the thorax clearly demonstrated the incomplete pericardial defect, the rim of which was heavily calcified and constricted the partially herniated right and left ventricles (Fig 1). Except for a mild focal compression at the junction of the middle and distal third of the left anterior descending coronary artery, there was no significant coronary artery abnormality on contrast angiography. On hemodynamic evaluation, no gradient was detected across the ventricular constriction. The CT findings were confirmed during surgical pericardiotomy (Fig 2). Since surgery, the patient has remained physically well and asymptomatic.

View larger version (91K): [in this window] [in a new window]   Figure 1. CT scan of thorax, depicting localized partial absence of pericardium with protrusion and compression of both ventricles through defect. Rim of defect was heavily calcified.

View larger version (105K): [in this window] [in a new window]   Figure 2. Intraoperative visualization and confirmation of pericardial anomaly. During surgery, a pair of bone cutters was required to cut through heavily calcified pericardial band, which was partially constricting herniated ventricles.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lau, K.-W. Articles by Ding, Z.-P. Search for Related Content PubMed PubMed Citation Articles by Lau, K.-W. Articles by Ding, Z.-P.