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(Chest. 1970;58:73-76.)
© 1970 American College of Chest Physicians

Coronary Artery Insufficiency Secondary to Congenital Pericardial Defect

T. Z. Lajos M.D., F.C.C.P.1; I. L. Bunnell M.D.2; B. P. Colokathis M.D.3; and G. Schimert M.D., F.C.C.P.4

1 Assistant Professor of Surgery
2 Associate Professor of Medicine
3 Resident in Thoracic Surgery
4 Associate Professor of Surgery

Localized narrowing of the left anterior descending coronary artery was demonstrated by preoperative selective coronary arteriography in a 33-year-old man with pericardial defect. At operation, the left ventricle was herniating through a partial pericardial defect, behind the phrenic nerve, into the left pleural cavity. The occlusive lesion in the anterior descending artery was noted to be precisely beneath the anterior rim of the pericardial defect. Release of the fibrous ring and re-location of the left phrenic nerve was followed by a bilateral Vineberg procedure. Postoperative selective angiography again revealed the narrowed left coronary artery and demonstrated functioning Vineberg pedicles. Pressure on the anterior descending coronary artery is suggested as a likely cause for the partial occlusive lesion demonstrated at this site and the symptoms of coronary insufficiency in this patient.




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