Congenital Pericardial Agenesis Diagnosed at Advanced Age and Treated Via Minimally Invasive Repair

Figure 1. Transthoracic Echocardiography Findings (A) When the patient was in the left lateral decubitus position, the left ventricle was displaced inferiorly in the end-diastolic phase, suggesting excessive cardiac mobility. (B) When the patient was in the supine position, this abnormal positioning was corrected during end-diastole, with the left ventricle returning to a more typical location. Lt = left.

Figure 2. Cardiac CT Findings Contrast-enhanced thin-slice cardiac CT revealed complete absence of discernible pericardial tissue surrounding the heart, with the myocardium in direct contact with the adjacent lung parenchyma. CT = computed tomography.

Figure 3. Cardiac Magnetic Resonance Imaging Findings CMR demonstrated persistent inferior displacement of the left ventricle throughout the cardiac cycle, as evident during both (A) systole and (B) diastole, consistent with excessive cardiac mobility. CMR = cardiac magnetic resonance imaging.

Figure 4. Intraoperative Thoracoscopic Images Thoracoscopic examination clearly demonstrated complete absence of the pericardium, with no pericardial tissue seen in either the (A) caudal or (B) cranial portion of the heart. (C) Pericardial reconstruction was subsequently performed by suturing a custom-made expanded polytetrafluorethylene (ePTFE) patch to the surrounding structures, thereby creating an artificial pericardium.

Figure 5. Preoperative and Postoperative CT Findings (A) Preoperative chest CT images showed no identifiable pericardial structure surrounding the heart, consistent with complete pericardial agenesis. (B) Postoperative imaging demonstrated that the reconstructed pericardium, created with a synthetic patch, adequately supported and stabilized the heart within the thoracic cavity. CT = computed tomography.

Figure 6. Follow-Up Cardiac Magnetic Resonance Imaging Follow-up CMR showed improvement in the previously observed inferior displacement of the left ventricle. Both (A) systolic and (B) diastolic images demonstrated a more normalized position of the heart, suggesting resolution of the patient's excessive cardiac mobility. CMR = cardiac magnetic resonance imaging.