Coronary artery disease in a patient with a congenital pericardial defect.

This case report summarizes our experience with a 43 year old male patient with congenital pericardial defect, involving the left ventricular part of the pericardium, and additionally 2-vessel coronary-artery disease in the absence of any coronary risk factors. This patient underwent coronary-artery bypass grafting. Intraoperatively the heart was found to be rotated and herniated into the left pleural cavity, strangulated by the remaining pericardium causing a bridle stricture of the right as well as the left margin of the heart, with a subsequent local narrowing of the ventricle in these areas. Furthermore, assessment of the coronary arteries at operation by external palpation showed the location of an RCA- and LAD-stenosis to match exactly with the stricture area.