Partial congenital pericardial defects are exceptionally uncommon and typically asymptomatic. In rare circumstances, cardiac herniation through the defect may precipitate mechanical strangulation with extrinsic coronary artery compression and myocardial infarction (MI). We describe a young man who presented with ST-elevation MI attributed to left ventricular (LV) herniation through a previously unrecognized pericardial defect. Despite a typical clinical presentation of MI, the highly atypical angiographic and echocardiographic findings required further investigation. Cardiac magnetic resonance was crucial for excluding alternative causes of LV wall thickening and coronary artery compression, such as tumors or infiltrative diseases, and contributed to identifying the pericardial defect. Although rare, partial pericardial defects should be considered in the differential diagnosis of acute coronary syndrome, especially in young patients with atypical presentations or findings.

Congenital pericardial defects (CPDs) are rare congenital abnormalities characterized by the complete or partial absence of the pericardium. They are often asymptomatic and discovered incidentally through imaging. Some individuals can experience non-specific symptoms, whilst others can have serious complications. The gold standard for diagnosing pericardial defects is cardiac MRI. Management is case-dependent and usually reserved for partial defects. Here, we present a case of a 57-year-old male who presented with recurrent chest pain and was found to have partial pericardial defect, a diagnosis missed on prior imaging, and discuss the diagnosis and management.

To report the safety and effectiveness of a modified Warden procedure. Twenty-six (26) patients underwent modified Warden surgery at our centre from September 2017 to September 2021. In all patients, the superior vena cava (SVC) was reconstructed by turning the atrial wall in the main body of the right atrium upwards and applying fresh autologous pericardial patches. There were 13 male patients and 13 female patients, and the median age of the patients was 7.0 (range, 0.3-47.0) years. The median follow-up time after surgery was 47.0 (range, 32.0-80.0) months. The aortic cross-clamp time was 108.50±34.72 minutes, the cardiopulmonary bypass time was 154.81±41.65 minutes, the median postoperative mechanical ventilation time was 8.5 (range, 0.0-91.0) hours, the median intensive care unit stay was 43.5 (range, 15.0-352.0) hours, and the median length of postoperative hospital stay was 7.0 (range, 6.0-19.0) days. All patients were safely and successfully discharged from the hospital. No deaths or sinus node dysfunction occurred during the follow-up period. The mean gradient of the reconstructed SVC and/or the right pulmonary vein (PV) increased in eight patients and decreased to less than 1 mmHg in six patients. One (1) adult patient had already undergone two vascular interventions, and one child had persistent stenosis but did not undergo reoperation at the time of the study. In addition, two patients were subjected to pericardial windowing. A modified Warden technique using a right atrial flap and autologous pericardium effectively corrected the high-plane connection between the PVs and SVC. This technique effectively avoids sinus node dysfunction; however, a short-term increase in the differential pressure of the re-established SVC or PV after the procedure is acceptable, and reintervention is required only in rare cases.

Pentalogy of Cantrell (POC) is a rare and often fatal congenital malformation characterized by a midline developmental defect involving five anatomical structures: the lower sternum, anterior diaphragm, diaphragmatic pericardium, abdominal wall, and heart. This condition presents significant diagnostic and therapeutic challenges, particularly in resource-limited settings where advanced imaging and surgical interventions are limited. Early diagnosis, supportive care, and strategic surgical planning with a multidisciplinary team are all key components in managing patients with POC. Here we present a case of a 32-year-old female (Gravidity 2 Parity 1 Living 1) presented to our specialty hospital in Northern Tanzania at 31 weeks and 3 days of gestational age for regular antenatal visit clinic with a complain of mild lower abdominal pain for 1 week. Obstetric ultrasound revealed a single fetus with an estimated gestational age of 31 weeks and 3 days and a 3.3 cm anterior chest wall defect with partial cardiac herniation, along with herniation of the liver, bowel, kidney, and urinary bladder with thoracolumbar kyphotic deformity was also seen. The radiological findings were consistent with limb body wall complex syndrome and POC. A multidisciplinary board team of obstetrician, pediatricians, surgeons and radiologist discussed the patient and planned for medical termination of the pregnancy. The patient was discharged home after receiving a psychological care. Psychological support was provided, and the patient remained emotionally stable during the follow-up. This case highlights the antenatal diagnostic and postnatal management challenges of POC in resource-constrained settings. Patients diagnosed with this condition should receive thorough antenatal counseling regarding the associated risks of morbidity and mortality. Currently, there are no established guidelines or studies defining the optimal mode of delivery for these cases. In case of severe malformations and or confirmed chromosomal abnormalities, and where legally permissible, pregnancy termination may be considered.

A 1.8-year-old, 7.7-kg male mixed-breed dog was examined before castration surgery. Thoracic radiographs showed a prominent bulging of the cardiac silhouette. Echocardiography revealed a partial absence of the bright pericardial signal in the right ventricular outflow tract. Fluoroscopy revealed a bulging pulsating sac anterior to the right ventricular outflow tract. On contrast-enhanced computed tomography, a balloon-shaped right ventricular lumen protruding in the cranial direction was seen on the cranial side of the right ventricle near the pulmonary infundibulum. Accordingly, right ventricular herniation due to a partial pericardial defect was diagnosed. This report describes cardiac computed tomography in dogs with right ventricular pericardial defects; our findings highlight the usefulness of fluoroscopic examination in diagnosing pericardial defects.