Chest pain is the most common presenting symptom among patients with congenital pericardial defects. A delay in diagnosis of a congenital pericardial defect occurred in a patient because he had concomitant atherosclerotic coronary artery disease. Multiple radiological studies had suggested the diagnosis. The pericardial defect caused myocardial ischemia by obstructing flow in three coronary arteries. Surgical repair of the pericardial defect along with coronary artery bypass grafting was performed to correct the problem.
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