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Pericardiectomy is the surgical removal of part or most of the pericardium. [1] [2] This operation is most commonly used to relieve constrictive pericarditis, or to remove a pericardium that is calcified and fibrous. [2] It may also be used for severe or recurrent cases of pericardial effusion. [3]
There are three pericardial sinuses: superior, transverse and oblique. [1] The superior sinus is anterior to the ascending aorta and the pulmonary trunk. [1] It cannot be assessed in electrophysiology procedures. [1] The oblique sinus is an inverted J-shaped reflection of the venae cavae and pulmonary veins. [2]
The pericardium (pl.: pericardia), also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. [1] It has two layers, an outer layer made of strong inelastic connective tissue ( fibrous pericardium ), and an inner layer made of serous membrane ( serous pericardium ).
The definitive treatment for constrictive pericarditis is pericardial stripping, which is a surgical procedure where the entire pericardium is peeled away from the heart. This procedure has significant risk involved, [ 14 ] with mortality rates of 6% or higher in major referral centers.
The pericardium is a fibrous sac surrounding the heart composed of two layers: an inner visceral pericardium and an outer parietal pericardium. [1] The area between these two layers is known as the pericardial space and normally contains 15 to 50 mL of serous fluid. [2]
Figure A shows the location of the heart and a normal heart and pericardium (the sac surrounding the heart). The inset image is an enlarged cross-section of the pericardium that shows its two layers of tissue and the fluid between the layers. Figure B shows the heart with pericarditis.
A serous membrane lines the pericardial cavity of the heart, and reflects back to cover the heart, much like an under-inflated balloon would form two layers surrounding a fist. Called the pericardium, this serous membrane is a two-layered sac that surrounds the entire heart except where blood vessels emerge on the heart's superior side; [4]
The pericardium is infiltrated by the fibrinous exudate. This consists of fibrin strands and leukocytes. Fibrin describes an amorphous, eosinophilic (pink) network. Leukocytes (white blood cells; mainly neutrophils) are found within the fibrin deposits and intrapericardic. Vascular congestion is also present.