A 71-year-old man with exertional chest pain was admitted to the hospital. A chest roentgenogram exhibited levoposition of the heart. An electrocardiogram showed clockwise rotation in the precordial leads and ST depression in V6, V7, V8, and V9 as well as in II, III, aVF leads associated with chest pain in a treadmill exercise test. The congenital complete left-sided pericardial defect could not be diagnosed preoperatively, but it was confirmed by thoracotomy.
Nasser WK, Helmen C, Tavel ME, et al: Congenital absence of the left pericardium: Clinical, electrocardiographic, radiographic, hemodynamic, and angiographic findings in six cases. Circulation41:469-478, 1970.
3.
Nguyen DQ, Wilsoon RF, Bolman RM III, et al: Congenital pericardial defect and concomitant coronary artery disease. Ann Thorac Surg72:1371-1373, 2001.
4.
Gassner I, Judmaier W, Fink C, et al: Diagnosis of congenital pericardial defects, including a pathognomic sign for dangerous apical ventricular herniation, on magnetic resonance imaging. Br Heart J74:60-66, 1995.
5.
Skalski J, Haponiuk I, Przybylski R, et al: A congenital defect of the pericardium. Thorac Cardiovasc Surg47:401-404, 1999.
6.
Lajos TZ, Bunnell IL, Colokathis BP, et al: Coronary artery insufficiency secondary to congenital pericardial defect. Chest58:73-76, 1970.
