Pericardium
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
The pericardium is made up of two main layers: a tough external layer known as the fibrous pericardium, and a thin, internal layer known as the serous pericardium. Enclosed within the fibrous pericardium, the serous pericardium is itself divided into two layers: the outer parietal layer that lines the internal surface of the fibrous pericardium and the internal visceral layer that forms the outer layer of the heart. Pericarditis may be followed by pericardial thickening, which can rarely present as constrictive pericarditis months or even years after the initial insult has passed. Diagnostic pericardiocentesis may also be performed if an infectious cause of acute pericarditis is suspected. Cardiac tamponade is a life-threatening syndrome that requires urgent treatment by pericardiocentesis with draining of the pericardial fluid by a percutaneous route. In recurrent pericarditis, the autoinflammatory mechanism may result from activation of the inflammasome by a cardiotropic virus or a nonspecific agent in a patient who has abnormal innate immunity.
The mitral valve
Andrew R. Houghton in MAKING SENSE of Echocardiography, 2013
The pericardium is visible in each of the standard imaging planes of the heart and should therefore be examined in each view. As the normal pericardium is thin it is not prominent on echo, but may appear as a thin bright line around the heart. Cardiac tamponade refers to the haemodynamic decompensation that occurs when the pressure within a pericardial effusion compresses the heart. Use pulsed-wave Doppler to assess right and left ventricular inflow and look for the exaggerated respiratory variation seen in tamponade. Echo guidance can help determine when the pericardiocentesis needle is correctly located within the pericardium. Thickening and fibrosis of the serous pericardium can constrict the heart, like a rigid envelope, impairing filling of the ventricles in diastole and leading to equalisation of the diastolic pressures in both ventricles. Congenital absence is a rare abnormality that can affect part or all of the pericardium.
The Pericardium
P. Chopra, R. Ray, A. Saxena in Illustrated Textbook of Cardiovascular Pathology, 2013
Heart is encased by the pericardium which has a visceral layer closely opposed to the heart and the parietal layer. In normal states it is thin, transparent and the myocardium can be seen through it. It shows a lining of flattened to cuboidal mesothelial cells. A great deal of difficulty can be encountered in distinguishing reactive mesothelial cell from cells shed from a mesothelioma and carcinoma. A final diagnosis in most of the cases rests on a combined evaluation of histological, histochemical and immunocyto-chemical findings in addition to clinical features of the thickened pericardium. Serous effusion is accumulation of clear or straw colored fluid in the pericardial cavity. Common causes include congestive heart failure, and hypoproteinemia. Myxedema, rheumatic fever, systemic lupus erythematosis are some of the other causes. Granulomatous inflammation with areas of necrosis is seen. The granulomas are bordered by chronic inflammation.
Novel pericardial access device: design features and
Published in Journal of Medical Engineering & Technology, 2011
P.M. Pollak, S. Mahapatra, J.K. Kanwal, G.T. Gillies
We have designed, built and tested a novel needle for percutaneously accessing the pericardial space. The problem with accessing pericardial space is that the pericardium is against the heart. Our novel device incorporates a single spiral tine at the distal tip of a10-gauge needle, which engages the parietal pericardium tangentially to the surface of the heart. One can then pull the pericardium away, thus minimizing the risk of ventricular perforation associated with oblique axial approaches. Using linear low-density polyethylene film as a surrogate pericardium, we have demonstrated reliable pericardial engagement with successful first-time engagement rates of up to 72% (n = 25 attempts) at approach angles ranging from 0° (normal incidence) to 30°. The associated torques were approximately 1 N mm. The performance limits of the model and the implications for clinical use of such a device are discussed.
Clinical long term results of glutaraldehyde-preserved heterologous pericardium in conjunctival surgery
Published in Orbit, 1990
Franz Josef Steinkogler, C. D. Scholda
A limited number of five patients presenting severe conjunctival malformations attributed to chemical burn or direct trauma, were treated with glutaraldehyde-preserved heterologous pericardium as conjunctival replacement material. After encouraging results in an experimental model, where pericardium patches were successfully used as temporary covering of conjunctival defects yielding a matrix for epithelialization, the authors started to utilize this material clinically. The positive results found in these experimental rabbit studies could not be completely verified in clinical use. After three to five years follow-up, the primary satisfying postoperative results were followed by partial, recurrent shrinking in all patients, in two patients even making further surgery necessary. Although in three patients improvement of the conjunctival fornix configuration was obtained, the long-term clinical results were not satisfying. As glutaraldehyde-preserved heterologous pericardium lacks comparable biocompatibility it cannot be recommended for clinical conjunctival surgery.
Glutaraldehyde-preserved heterologous pericardium for the repair of conjunctival defects Experimental study
Published in Orbit, 1985
A new material for conjunctival reconstruction was studied in a rabbit model. Conjunctival defects of a size up to 10 mm2 were covered with a specially thin (up to 0.5 mm) glutaraldehyde-treated pericardium patch. Conventional running suture fixation of the patch was compared with a fibrin glueing technique. Macroscopical findings during the follow-up time as well as histological investigations are reported. The best results were observed with thin, glued pericardium, yielding a matrix for re-epithelialization.
Related Knowledge Centers
- Cardiac Muscle
- Heart
- Great Vessels
- Inferior Vena Cava
- Aorta
- Superior Vena Cava
- Epicardium