Emergency surgical repositioning and heterologous pericardial patch placement successfully treated cardiogenic shock caused by congenital absence of the left pericardium in a 65-year-old man.
Case Report (n=1)
Congenital absence of the left pericardium can present as a life-threatening surgical emergency with cardiogenic shock, requiring urgent surgical repair to restore hemodynamic stability.
Abstract Background Congenital absence of the pericardium is a rare and often incidental finding, but it may present with severe cardiovascular compromise in exceptional situations. Case summary A 65-year-old man presented with cardiogenic shock associated with diffuse ST-segment elevation and severe metabolic acidosis. CT imaging excluded aortic dissection but revealed marked cardiac levorotation suggestive of left pericardial agenesis. Given ongoing hemodynamic instability, the patient underwent emergency surgery, which confirmed complete absence of the left pericardium. The heart was repositioned and a heterologous pericardial patch placed. Postoperatively, the patient gradually recovered, requiring short-term renal replacement therapy, and was discharged to rehabilitation. Discussion This case highlights a rare but life-threatening presentation of congenital pericardial agenesis. Early recognition and urgent surgical intervention were key to restoring hemodynamic stability. Conclusion Clinicians should consider this diagnosis when encountering unexplained cardiac displacement or shock, as timely surgical repair can be lifesaving.
Piccoli et al. (Thu,) conducted a case report in Congenital absence of the left pericardium (n=1). Emergency surgery (heart repositioning and heterologous pericardial patch placement) was evaluated. Emergency surgical repositioning and heterologous pericardial patch placement successfully treated cardiogenic shock caused by congenital absence of the left pericardium in a 65-year-old man.