The Pericardium
The pericardium is a unique structure that surrounds the heart and serves several important physiological roles. The removal of the pericardium, certain pericardial disorders, or the buildup of fluids within this space will ultimately alter hemodynamic pe
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Eric S. Richardson, Alexander J. Hill, Nicholas D. Skadsberg, Michael Ujhelyi, Yong-Fu Xiao, and Paul A. Iaizzo
Abstract
The pericardium is a unique structure that surrounds the heart and serves several important physiological roles. The removal of the pericardium, certain pericardial disorders, or the buildup of fluids within this space will ultimately alter hemodynamic performance. Recent therapeutic approaches have been directed to exploit the space that exists between the pericardium and the epicardial surface of the heart. New devices and techniques are being developed to access this space with minimally invasive approaches. The pharmacokinetics of many drugs may be greatly enhanced if the drug is delivered into the pericardium. As more is learned about the pericardium, it may play a significant role in cardiac therapies. Keywords
Pericardium • Pericardial fluid • Mechanical effects • Pericardial disorders • Comparative anatomy • Intrapericardial therapeutics
9.1
Introduction
The pericardium is a fibroserous conical sac structure encasing the heart and roots of the great cardiac vessels. In humans, it is located within the mediastinal cavity posterior to the sternum and cartilages of the 3rd through 7th ribs of the left Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3-319-19464-6_9) contains supplementary material, which is available to authorized users. E.S. Richardson, PhD (*) Department of Bioengineering, Rice University, 6500 Main Street, Suite 525, Houston, TX 77030, USA e-mail: [email protected] A.J. Hill, PhD • N.D. Skadsberg, PhD M. Ujhelyi, PharmD, FCCP • Y.-F. Xiao, MD, PhD Medtronic, Inc., Minneapolis, MN, USA Y.-F. Xiao, MD, PhD University of Medicine and Dentistry of New Jersey, Newark, NJ, USA P.A. Iaizzo, PhD Department of Surgery, University of Minnesota, Minneapolis, MN, USA
thorax and is separated from the anterior wall of the thorax. It is encompassed from the posterior resting against the bronchi, the esophagus, the descending thoracic aorta, and the posterior regions of the mediastinal surface of each lung. Laterally, the pericardium is covered by the pleurae and lies along the mediastinal surfaces of the lung. It can come into direct contact with the chest wall near the ventricular apical region, but this varies with the dimensions of the long axis of the heart or with various disease states. Under normal circumstances, the pericardium separates and isolates the heart from contact by the surrounding tissues, allowing freedom of cardiac movement within the confines of the pericardial space (Fig. 9.1).
9.2
Anatomy
In humans, the 1–3 mm thick fibrous pericardium is commonly described as a flask-shaped bag. The neck of the pericardium (superior aspect) is closed by its extensions surrounding the great cardiac vessels, while the base is attached to the central tendon and to the muscular fibers of the left side of the diaphragm (Fig. 9.2). Much of the pericar-
© Springer International Publishing Switzerland 2015 P.A. Iaizzo (ed.), Handbook of Car
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