Off-pump coronary artery bypass in congenital absence of pericardium.

Off-pump coronary artery bypass involves precise manipulations for proper positioning the heart without causing hemodynamic compromise. Pericardial stay sutures exerting appropriate traction play an important role in off-pump surgery. We report a rare case in which a congenital pericardial defect was discovered after sternotomy in a patient undergoing off-pump coronary artery bypass.