Congenital Partial Pericardial Defect with Herniation of the Left Atrial Appendage

Rogge, James D.

doi:10.7326/0003-4819-64-1-137

Cited by 21 publications

(5 citation statements)

References 14 publications

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“…Several cases of atrial appendage protrusion through a left pericardial defect have been reported [12][13][14][15][16][17][18][19]. Pericardial defects may be associated with rhythm disturbances due to not well-established pathophysiologic mechanisms.…”

Section: Commentmentioning

confidence: 99%

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

Misthos¹,

Neofotistos²,

Drosos³

et al. 2009

International Journal of Cardiology

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Section: Commentmentioning

confidence: 99%

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

Misthos¹,

Neofotistos²,

Drosos³

et al. 2009

International Journal of Cardiology

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“…Saint Pierre and Froment (1970) collected from the literature five deaths due to herniation of the left ventricle. No deaths due to herniation of the left atrium or its appendage were reported by Rogge, Mishkin, and Genovese (1966). PHYSICAL SIGNS Among 27 cases of isolated partial defect we noted that 16 were without physical signs, while in 11 cases there was a systolic murmur localized to the second or third left intercostal space.…”

Section: Discussionmentioning

confidence: 92%

Partial left pericardial defect with herniation of the left atrial appendage

Pernot

Henry

et al. 1972

Thorax

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A case is reported of herniation of the left atrial appendage through a partial pericardial defect, probably congenital. The diagnosis was suggested by the history of chest pain and bulging of the middle segment of the left heart border on the plain chest film, without other signs. Angiography revealed a dilated left atrial appendage. An artificial left pneumothorax confirmed the presence of a pleuropericardial defect. The surgical procedure included excision of the appendage and closure of the defect. G.M., a 17-year-old male student, was admitted because of constrictive chest pain. There was no typical irradiation but for several months the pain appeared after effort. The first painful crisis with syncope and intense pallor occurred during a game of football.Fluoroscopy revealed a pseudomitral pattern of the left heart border. The lack of other signs ruled out mitral stenosis, atrial septal defect, pulmonary valvular stenosis, and primary pulmonary hypertension. A diagnosis of dilatation of the left atrial appendage was suggested but a mediastinal tumour could not be excluded. After this first crisis the boy suffered from other less severe chest pains, always related to effort. He was admitted to the University Hospital for further investigation.Physical examination revealed a well-developed young man, 56 6 kg in weight and 166 cm in height. On auscultation a physiological double second sound was heard and was confirmed by phonocardiography. A chest radiograph and fluoroscopy showed a localized, pulsating bulge of the left atrial appendage. The electrocardiogram was normal: axis +60°, PR interval a little short (0n12 sec), ventricular depolarization normal with, during repolarization, slight upper deviation of the ST segment with T biphasic in V2 and V3, and bifidity of T in V4.Right heart catheterization revealed a slight increase of pressure in the right atrium but no other abnormality. The results were: right atrium+8/-6 mean=7 mmHg; right ventricle+30/-5 mean=10 mmHg; pulmonary artery + 30 / -8 mean = 14 mmHg; pulmonary capillaries + 10 / -6 mean = + 8 mmHg.Oxymetry was normal. Retrograde left ventricular catheterization confirmed normal pressure in the aorta and the left ventricle.Selective angiography of the pulmonary artery showed that it was normal, but when the left atrium was opacified a champagne cork shaped density related to the dilated left appendage could be seen. The diagnosis was confirmed by means of a diagnostic pneumothorax following the injection of 400 ml of air into the left pleural cavity. Chest radiographs were taken in the frontal, right anterior oblique, and left lateral decubitus positions with a horizontal beam. 246 on 12 May 2018 by guest. Protected by copyright.

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“…1). Cineangiography, demonstrating hemiation of the left atrial appendage beyond the left heart border, is considered diagnostic of partial absernce of the left pericardium by several authors.Y0 [33][34][35][36][37] This procedure is usually not diagnostic for complete left-sided pericardial defects. Pneumopericardium, following induction of artificial pneumothorax, is the procedure of choice for diagnosing complete absence of the left pericardium.…”

Section: Discussionmentioning

confidence: 99%

“…Also, the absence of pneumopericardium following artificial pneumothorax does not rule out absence of the pericardium since, in some cases, adhesions could conceivably prevent the accumulation of air in the pericardial space."' 13,17,19,35 Experimental studies in which total or partial resection of the pericardium was performed in 65 dogs led to the conclusion that no impairment of cardiac function nor dilatation of the heart resulted in any of the animals. 29 That disturbance of normal cardiac function does not appear to be present in patients with complete pericardial defects is suggested by two patients in the present series: both had large defects without intrinsic heart disease, and both had normal intracardiac hemodynamics (table 2, cases 4 and 6).…”

Section: Discussionmentioning

confidence: 99%

Congenital Absence of the Left Pericardium

et al. 1970

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Until the past decade, the diagnosis of congenital absence of the pericardium, partial or complete, had rarely been made prior to postmortem examination or thoracotomy. Since 1963, the condition has been recognized during life in six patients at this institution. Of these six patients, two had partial absence of the left pericardium and four had complete absence of the left pericardium. Characteristic roentgenologic findings were present in all six patients. Associated heart lesions were not present in either patient with a partial pericardial defect. Two of the remaining four had associated heart lesions. One patient had surgical repair of an atrial septal defect. Surgical repair of the pericardial defect was not attempted in any of the six patients. Hemodynamic determinations at rest were normal in all six patients. The two patients with partial pericardial defects, however, had elevation of the pulmonary artery and left ventricular end-diastolic pressures during mild exercise in the recumbent position which suggests that this type of defect is not totally innocuous. In view of the unusual and extreme cardiac mobility in this condition, it is conceivable that a portion of the heart could herniate and transiently incarcerate through the partial defect during exercise. It is suggested that partial pericardial defects may warrant surgical repair. Small defects or complete absence of the left pericardium, however, are apparently without lethal potential and do not require surgical intervention.

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Congenital Partial Pericardial Defect with Herniation of the Left Atrial Appendage

Cited by 21 publications

References 14 publications

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

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

Partial left pericardial defect with herniation of the left atrial appendage

Congenital Absence of the Left Pericardium

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