Complete Absence of the Left Pericardium and Pulmonary Hypoplasia in an Adult

A 54-year-old male patient presented to the Heart Clinic, Tehran, Iran, in 2018 with a history of chest pain for the previous six months. He had a relevant medical history of smoking and hyperlipidaemia. Coronary angiography revealed severe triple-vessel coronary artery disease. He was referred to the Heart Clinic for a coronary artery bypass graft (CABG). Physical examinations of the patient were normal and chest radiographic findings were normal with the exception of a cardiac silhouette that was displaced to the left [Figure 1]. Echocardiography showed a mild left ventricular dysfunction. Electrocardiography showed a normal sinus rhythm. Subsequently, the patient was scheduled to undergo CABG. During the procedure, a complete left pericardial defect and pulmonary hypoplasia were detected [Figure 2]. The left anterior descending artery was bypassed with the left internal mammary artery and a triple saphenous vein graft was done to bypass the right coronary, obtuse marginal and diagonal arteries. This defect was asymptomatic without creating pressure on the heart structures such as the left atrial appendage (LAA) or myocardium. Therefore, no intervention was performed for the defect. At the end of the surgery, a left chest drain was inserted for the defect. The patient recovered fully and was discharged on the sixth post-operative day. The patient gave his consent for publication of this report and its accompanying images. Open in a separate window Figure 1 Chest X-ray of a 54-year-old male patient presenting to the Heart Clinic, Tehran, Iran, in 2018 showing leftward displaced heart. Open in a separate window Figure 2 Intra-operative photograph of the heart showing absence of pericardium and pulmonary hypoplasia in a 54-year-old male patient presenting to the Heart Clinic, Tehran, Iran, in 2018.