Work

PCI Challenges in Congenital Pericardial Agenesis

Year: 2026

Type: article

Abstract: BACKGROUND: Congenital pericardial agenesis (CPA) is a rare congenital condition, typically asymptomatic and incidentally discovered. It alters cardiac orientation and coronary take-off, complicating coronary access and intervention. CASE SUMMARY: A 71-year-old man presented with unstable angina. His electrocardiogram showed sinus bradycardia and extreme right-axis deviation without acute ischemic changes. Coronary angiography via radial access failed due to inability to engage the left main. Femoral access was required, and severe calcified left anterior descending stenosis was treated with rotational atherectomy and multiple drug-eluting stents. Cardiac computed tomography revealed complete left-sided pericardial agenesis with cardiac displacement. The patient recovered well with preserved ejection fraction and was asymptomatic at follow-up. DISCUSSION: CPA displaces the heart and alters coronary angulation, creating challenges in guiding catheter selection, support, and wire advancement. This case illustrates how early recognition of CPA, combined with tailored catheter and device strategy, can facilitate successful percutaneous coronary intervention. TAKE-HOME MESSAGES: Congenital pericardial agenesis should be suspected when coronary engagement is difficult and imaging appears "off-axis." Early diagnosis facilitates tailored percutaneous coronary intervention strategy for safer and more efficient revascularization.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106552