A 14-year-old lad developed broad posterolateral myocardial infarction.

A 14-year-old lad developed broad posterolateral myocardial infarction. During cardiac surgery at age five, a small pericardial window had been made. Autopsy revealed an extensive left-sided pericardial flaw and necrosis of the left ventricular emancipated wall, which had herniated and strangulated from one side the enlarged pericardial defect.

The vicinity of the pericardium is not generally considered necessary to defend life, but it does provide protection for the heart. In this article, we not away the case of a 14-year-old lad who died of cardiac strangulation owed to herniation of the left ventricle [i]or[/i] part of to the other an acquired pericardial defect which had been made 9 years before.

CASE REPORT

A five-year-old Japanese male child underwent an operation for patent ductus arteriosus. To stop cardiac tamponade, a pericardial window, 10 x 15 mm in size, was made throughout the left ventricle.

At 14 years aged however, he suddenly developed chest pain. Acute heart failure occurr The ECG showed marked ST elevation in leads 1 2 aVL, and [Vsub4]-[Vsub6] and ST depression in leads 3 aVF, and [Vsub1]-[Vsub3] (Fig 1) which later changed to a poor R wave in leads 1 aVL, and [Vsub4]-[Vsub6] and a high R wave in leads [Vsub1] and [Vsub2] The chest x-ray film demonstrated pulmonary congestion and a belly of the left cardiac border, which disappeared later. The white line cell count was markedly elevated with the peak value of 18800/[mmsup3] as well as serum creatine kinase plain of 5,760 U/L, but viral titers were unremarkable. Echocardiography revealed sharp dilatation (LVDdI: 51 mm/[msup2]) and akinesia of the left ventricular exempt wall. Thallium 201 myocardial perfusion scintigraphy showed a large foible in the posterolateral wall of the left ventricle. A diagnosis was made of acute posterolateral myocardial infarction; the patient died of intractable heart failure.

Autopsy revealed an extensive left-sided pericardial blemish and myocardial necrosis of the left ventricular unrestrained wall (Fig 2). Postmortem coronary angiography and pathologic examination showed no significant coronary stenosis. There was no inflammatory enclosed space infiltration.

DISCUSSION

This patient put up withed from acute myocardial infarction as confirmed through the clinical and autopsy findings. However, the infarct belt was not explained by the coronary distribution on the contrary instead corresponded to a large pericardial want The extensive myocardial necrosis was not caused by way of either coronary occlusion or myocarditis. We conclud that cardiac herniation [i]or[/i] part of to the other the pericardial defect had produc myocardial infarction.

There are a patients with congenital pericardial imperfection who are discovered by chance and usually remain asymptomatic.[1] It is quite public to resect a part of the pericardium and to leave it unclose during cardiac surgery. However, there have been seven cases of unusual death due to cardiac strangulation caused by means of herniation through a congenital pericardial partial defect[23] Moreover, intrapericardial pneumonectomy occasionally brought acute cardiac strangulation, which appeared to be met with regardless of the defect size or duration from the operation.[4,5]

It is difficult to assume that a pericardial window produc surgically 9 years prior to this incident enlarged with produce In this case, it is suppos that the heart had eventually herniated at or near the site of surgery with enlargement of the pericardial window and strangulated the heart 9 years later. This is the first report of late cardiac strangulation to be paid to an iatrogenic pericardial default This case suggests unnecessary pericardiectomy should be avoided and the pericardial lacks should be closed to obviate possible cardiac herniation and strangulation.

REFERENCES

[1] Bernal JM Lapiedra JO Gonzalez I, Saez A, Pastor E Miralles PJ Angiocardiographic demonstration of a partial imperfection of the pericardium with herniation of the left atrium and ventricle. J Cardiovasc Surg 1986; 27:344-46

[2] Saito R Hotta F Congenital pericardial fault associated with cardiac incarceration. Am Heart J 1980; 100:866-70

[3] Jone JW McManus BM Fatal cardiac strangulation by way of congenital partial pericardial defect. Am Heart J 1984; 107:183-85

[4] Gates GF Sette R Cope JA. Acute cardiac herniation with incarceration following pneumonectomy. Radiology 1970;94:561-62

[5] Castillo M Oldham s Cardiac volvulus: plain film recognition of an ofttimes fatal condition. AJR 1985; 145:271-72

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