Right-side congenital pericardial defect associated with ischemic heart disease

We report an unusual right-side congenital pericardial defect with herniation of the right atrium to the right thoracic cavity found intraoperatively in a 73-year-old man undergoing coronary artery bypass grafting for triple-vessel coronary artery disease. The right atrial wall showed fibrous changes due to contact with the defect edge. We suspected that the right coronary artery was obstructed by chronic strangulation of the right atrium. We repaired the defect with a polytetrafluoroethylene patch to prevent it from compressing the bypass graft and coronary arteries.