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PubMedDate not supplied

Incidental localized (solitary) epithelial mesothelioma of the pericardium: case report and literature review.

Primary mesotheliomas of the pericardium are rare tumors. They may occur in diffuse, multiple, and localized forms. Most of the pericardial mesotheliomas are multiple or diffuse growths encasing the heart, localized forms being distinctly uncommon. We report a localized mesothelioma of the pericardium found incidentally at the autopsy of a 76-year-old woman. The neoplasm measured 3.6 x 2.4 x 2.5 cm., was well circumscribed, and affected the entire thickness of the myocardium extending from the epicardium to the endocardium of the anterior wall of the right ventricle. The tumor was epithelial in type, showed an immunohistochemical profile compatible with mesothelioma, and was DNA aneuploid. A review of the literature yielded four cases of localized pericardial mesothelioma, including the present. Most cases are seen in women and are of the epithelial variant. There is a wide age range at presentation. Localized mesotheliomas are capable of aggressive behavior. Nevertheless, in contrast to diffuse tumors, complete surgical excision may be curative. Differential diagnosis includes solitary fibrous tumor, synovial sarcoma, epithelioid angiosarcoma, and adenomatoid tumor of the pericardium.

Adenoma↗
PubMed1982

Tympanic membrane grafting with fascia, pericardium and vein.

Fascia and preserved homologous vein and pericardium have been used in consecutive order in 250 ear operations. Though successful closure of the defect, in cases with chronic ear infection, tended to be better with pericardium, auditory gain with pericardium seemed to be less than with fascia and vein. The differences, however, were not statistically significant. For the reason that it is easier to obtain, vein is the graft of choice in our institution when homologous graft is needed.

Cholesteatoma↗
PubMed2006

Absent pericardium: at risk for endocarditis?

A 16-year-old girl with no previous cardiac problems presented to the casualty with septic shock. Investigations revealed endocarditis involving the mitral valve. At the time of surgery, she was noted to have a large left atrial appendage herniating into the left pleural cavity due to partial absence of the pericardium. Complete or partial absence of the pericardium is an uncommon congenital anomaly. Though various complications and presentations are reported, it has not been identified as a risk factor for endocarditis. We discuss the possible mechanism, and need for prophylaxis against endocarditis, in patients with absence of the pericardium.

Adolescent↗
PubMed1987

Closure of the pericardium using expanded polytetrafluoroethylene GORE-TEX-Surgical Membrane: clinical experience.

Complete closure of the pericardium after cardiac operation would have the advantage of avoiding injury of the heart and great vessels should repeat sternotomy prove to be necessary. In such situations, various pericardial closure techniques have been described. Synthetic materials produced severe scarring, while xenografts appeared to be satisfactory, although fibrous reactions and aseptic cystic formations have been reported recently. Between 1985 and 1986 we closed the pericardium with GORE-TEX-Surgical Membrane in a selected series of 72 patients aging 1 month to 76 years, median 24 years. Overall hospital mortality was 3/72 cases. In no instance was there a relationship between death occurrence and pericardial closure through Surgical Membrane. There were 5 cases each of low cardiac output and rethoracotomy because of bleeding. No cardiac tamponade occurred. Two patients had to be reoperated three and four weeks after primary repair. Surgical Membrane was explanted. Electron microscopy examination showed no cellular ingrowth in the low porosity membrane. No immunocompetent cellular compounds were present on either side of the graft. Follow-up interval averaged 13 months. No complication related to pericardial closure has occurred until now. The Surgical Membrane has the advantages of easy availability, of lack of reactions both between its surface and the underlying epicardium and with the rest of the pericardium. We believe its routine use should be encouraged mainly in patients with high probability of reoperation.

Adolescent↗
PubMed1998

Buttressing staple lines with bovine pericardium in lung resection for bullous emphysema.

The utility of buttressing an endoscopic mechanical stapler with strips of bovine pericardium in resection of pulmonary bullous areas was evaluated by comparing the duration of air leakage in two randomized patient groups, one with and one without buttressing. The duration of air leakage was not related to bulla size in either group but showed a linear relation with the radiologic emphysema score in both groups (p < 0.001) and was shorter when the stapler had been fitted with bovine pericardium, but significantly reduced (p = 0.019) only in patients with a high emphysema score. The duration of air leakage was thus related to emphysema score, and in patients with high scores was shortened by application of bovine pericardium to the stapler.

Adult↗
PubMed1993

Ventricular coupling via the pericardium: normal versus tamponade.

OBJECTIVE: The aim was to examine how regional variations in pericardial pressure affect the mechanical coupling between the ventricles. METHODS: Canine hearts from 14 dogs (14.5-18 kg) were removed and placed in cold cardioplegia solution. Balloons were inserted into the left and right ventricles and the atria. Pericardial pressure over the left ventricle (Pclv) and the right ventricle (Pcrv) was measured with thin balloon catheters. Ventricular and pericardial pressures were measured, and ventricular and pericardial coupling was calculated, under control conditions and with increases in pericardial tension and fluid. RESULTS: At baseline, regional differences in pericardial pressure occurred [Pclv > Pcrv, 4.0(SD 0.9) v 2.9(0.6) mm Hg, p < 0.05]. Ventricular coupling via the pericardium was defined as delta Pclv/delta Pcrv for right ventricular volume increases and delta Pcrv/delta Pclv for left ventricular volume increases. This ratio increased more after increasing right ventricular volume than after increasing left ventricular volume [delta Pclv/delta Pcrv > delta Pcrv/delta Pclv, 1.14(0.33) v 0.51(0.15), p < 0.05]. Increasing the pericardial tension by clamping the pericardium increased pericardial pressures, yet did not alter the regional variations in pressure [Pclv > Pcrv, 8.4(2.2) v 6.4(2.5) mm Hg, p < 0.05] or pericardial coupling [delta Pclv/delta Pcrv > delta Pclv/delta Pcrv, 1.18(0.46) v 0.54(0.16), p < 0.05]. In contrast, creating a mild tamponade increased pericardial pressures, eliminated regional differences in pressure, and altered the coupling between ventricles [delta Pclv/delta Pcrv approximately delta Pclv/delta Pcrv, 0.95(0.11) v 1.05(0.08), p = NS]. These regional differences in pericardial pressure might have a geometrical basis. In four in vivo canine experiments using cine magnetic resonance, the short axis radius of curvature for the right ventricle was greater than for the left ventricle [38.3(4.4) mm v 29.2(3.8) mm, p < 0.05]. CONCLUSIONS: The pericardium partially protects right ventricular filling: regional differences in pericardial pressure normally occurred with lower pericardial pressure over the right ventricle, and left to right ventricular coupling was less. This protection of right ventricular filling was lost with even a small pericardial effusion.

Animals↗
PubMed1997

Teicoplanin concentrations in serum, pericardium, pericardial fluid and thoracic wall fat in patients undergoing cardio-pulmonary bypass surgery.

The concentrations of teicoplanin in serum, pericardium, pericardial fluid and thoracic wall fat were measured in patients undergoing cardio-pulmonary bypass (CPB) after the administration of a single i.v. 12 mg/kg dose. Five minutes after the start of CPB, teicoplanin serum concentrations decreased by, on average, 35% (95% confidence interval (CI): 28-42%) and remained significantly lower than the expected values over the subsequent 60 min period. After aortic unclamping drug concentrations rebounded but remained significantly lower than the expected values in the next 60 min. Immediately before CPB, penetration of teicoplanin in pericardium and thoracic wall fat was 0.44 (95% CI: 0.23-0.65) and 0.05 (95% CI: 0.03-0.7), respectively, and increased at the end of CPB to 0.90 (95% CI: 0.55-1.25) and 0.17 (95% CI: 0.05-0.29), respectively. MICs for most staphylococcal strains were attained during CPB procedure in pericardium but not in thoracic wall fat. However, since staphylococcal infections involve the interstitial space it is likely that penetration into fat cells is not important for antimicrobial prophylaxis. In this respect, it is worth noting that drug concentration in pericardial fluid, which should reflect the interstitial concentration, was higher than the MIC for most staphylococcal strains. Although no infective complications were observed in our limited series of patients, larger clinical trials are needed to assess whether the dose regimen employed is effective in preventing post-CPB surgery infections.

Adipose Tissue↗
PubMed1994

Blunt traumatic rupture of the heart, pericardium, and supradiaphragmatic inferior vena cava: case report.

Before 1955 blunt traumatic ruptures of the heart and pericardium were reported almost exclusively in autopsy reports. Since then, because of improved prehospital care and early triage, it has been demonstrated that injuries resulting in rupture of the heart and pericardium are no longer always fatal. We present a case of a patient who arrived at the hospital with increasing abdominal girth and a tender abdomen who on exploration was found to have a tear of the pericardium and atrial appendage compounded by a supradiaphragmatic tear of the inferior vena cava.

Accidents, Traffic↗
PubMed2001

Imaging of the pericardium.

Computed tomography (CT) and magnetic resonance imaging (MRI) are modalities well suited for imaging of the pericardium and pericardial disease. Both offer excellent resolution with a wide field of view. Both have advantages and disadvantages when compared with each other and with echocardiography. Establishing the diagnosis of constrictive pericarditis is a common indication for CT or MRI of the pericardium. Pericarditis, neoplasms, effusions, and congenital anomalies are additional conditions involving the pericardium that can be diagnosed with CT and MRI.

Heart Neoplasms↗
PubMed2006

Pericardium membrane and xenograft particulate grafting materials for horizontal alveolar ridge defects.

PURPOSE: The purpose of this study was to evaluate the clinical feasibility of using a native collagen physical resorbable barrier made of bovine pericardium to augment localized alveolar ridge defects for the subsequent placement of dental implants. MATERIALS & METHODS: There were 8 systemically healthy patients with 19 implant sites (aged 35 to 68 years), with inadequate dental alveolar ridge widths, selected for study. All patients completed initial therapy, which included scaling, root planning, and oral hygiene instruction. All ridge defects were augmented with bovine xenograft and a collagen pericardium membrane. Horizontal (width) hard tissue measurements were taken the day of ridge augmentation surgery, or implant placement and augmentation (baseline), and at the 6-month (reentry or uncovering) surgery. RESULTS: The change in ridge width varied from a loss of 0.2 mm to a gain of 7.8 mm, measured clinically with a mean value of 3.0368 and a median of 2.8 mm from baseline. CONCLUSIONS: The results suggested that pericardium collagen membrane may be a suitable component for augmentation of localized alveolar ridge defects in conjunction with different xenografts.

Adult↗
PubMed2001

Influence of the selection of the suture material on the mechanical behavior of a biomaterial to be employed in the construction of implants. Part 1: Calf pericardium.

A hydraulic stress simulator was employed to study the mechanical behavior of the calf pericardium used in the construction of cardiac valve leaflets. One hundred eighty pairs of tissue samples were subjected to tensile testing to rupture. One of the two samples from each of 144 pairs (four series of 36 pairs each) was sutured with commercially available threads made of nylon, silk, Prolene or Gore-Tex, while the other sample in each of these pairs was left unsewn. The remaining 36 pairs were employed as controls in which neither of the two samples was subjected to suturing. The sutured tissue samples showed a significant decrease in tensile strength at rupture (range: 11.81 to 26.04 MPa) when compared with unsutured samples (range: 39.38 to 87.96 MPa; p < 0.01). The application of morphological and mechanical selection criteria to maximize the homogeneity of the samples provided excellent fit with respect to the stress/strain curves. This method made it possible to carry out a predictive study of the mechanical behavior of a sutured sample, based on that observed in the corresponding unsutured fragment. The interaction of the different suture materials with the pericardial tissue was also assessed by comparing the mechanical behavior of the sutured samples with that of the control samples. At stresses of less than 0.8 MPa, samples sewn with Gore-Tex were found to show the least difference with respect to the controls, indicating that this material presented the lowest degree of interaction with the pericardium. In conclusion, the degree of the loss of resistance to tearing of the sutured samples is of no value in the selection of the optimal suture material. The selection process applied makes it possible to predict the mechanical behavior in response to suturing of a given unsewn tissue specimen by determining that of its sutured mate. The similarity between the findings in samples sewn with Gore-Tex and in the unsutured controls indicates a lesser degree of interaction between the suture material and the pericardium employed in the construction of cardiac valve leaflets.

Animals↗
PubMedDate not supplied

Spindle cell sarcoma of the pericardium: a case report.

Malignancy of the pericardium is a very rare entity. We describe here a case of a 38-year-old male admitted because of chest pain and shortness of breath. Following magnetic resonance imaging and CT-guided biopsy of the mediastinal mass, spindle cell sarcoma of the pericardium was diagnosed. The tumor was deemed unresectable due to invasion of vital mediastinal structures. The patient then underwent neoadjuvant chemotherapy with three cycles of ifosfamide, doxorubicin, and mesran. This resulted in a noticeable reduction in tumor size confirmed by follow-up magnetic resonance imaging and repeat transesophogeal echo. Both studies showed marked reduction in tumor bulk with no obvious invasion of the left atrium or pulmonary veins. The pericardial mass was resected utilizing cardiopulmonary bypass through a left thoracotomy in order to remove the tumor from the superior pulmonary veins and pulmonary hilum. The patient was discharged on postoperative day 6. Spindle cell sarcoma of the pericardium is a very rare tumor and other pericardial sarcomas may be best treated by combined neoadjuvant therapy followed by aggressive surgical resection when necessary, possibly utilizing cardiopulmonary bypass.

Adult↗
PubMed1993

The pericardium reinforced suture annuloplasty: another tool available for mitral annulus repair?

From May 1985 to May 1992, 169 patients underwent surgery for mitral valve repair. In 87% of these patients, the valve reconstruction involved the mitral annulus. At the beginning, in an effort to preserve systolic movement of the annulus and avoid the implant of prosthetic materials inside the heart, we mainly used simple suture annuloplasty in 66 patients. When we reoperated upon three patients only a few months after reconstruction of the mitral valve for a dehiscence of the suture annuloplasty, we decided to perform ring annuloplasty with the Carpentier ring in 23 patients. Though we have not seen any problems with the Carpentier ring in our series, we performed a suture annuloplasty reinforced with a strip of autologous pericardium to eliminate all prosthetic material. Since introducing this technique in 1989, we have used this annuloplasty in 58 patients. We have not observed any dehiscence of the suture or other complications related to this procedure. Three patients with a pericardial annuloplasty underwent reoperation for other reasons; the autologous pericardium was perfectly attached to the annulus, covered by a smooth layer of fibrous tissue without calcification. After this encouraging initial experience, we believe that long-term follow-up is necessary to confirm that autologous pericardium is an effective method of mitral annulus repair.

Heart Valve Diseases↗
PubMed1981

Role of the pericardium and intact chest wall in the hemodynamic response to positive end-expiratory pressure ventilation.

The mechanism for the reduction of both systemic arterial blood pressure and cardiac output (CO) and for the elevation of intravascular pressure which accompanies positive end-expiratory pressure ventilation (PEEP) remains uncertain. The role of the intact pericardium and the chest wall has not been defined. This study examines cardiac transmural pressure with PEEP (0, 4, 8, and 16 cm H2O) administration in nine closed chest, anesthetized, normovolemic dogs utilizing direct measurements of intrapericardial pressure. The experiment was repeated following pericadiectomy and left thoracotomy. The closed chest dogs exhibited significant reductions in blood pressure and CO without detectable changes in transmural pressure. With combined pericardiectomy and left thoracotomy, the responses of both CO and blood pressure to PEEP were similar to those observed with the chest closed. Absolute right atrial pressures were similar at all levels of PEEP and were independent of the presence of the pericardium and the intact chest wall. The rise in absolute left atrial pressure observed with these structures intact was completely abolished by pericardiectomy and left thoracotomy. Thus the major hemodynamic effects of PEEP, namely changes in blood pressure and CO, cannot be accounted for by changes in transmural pressure or influences from the intact chest wall and pericardium.

Animals↗
PubMed2005

Atomic force microscopy investigation of chemically stabilized pericardium tissue.

Native and chemically stabilized porcine pericardium tissue was imaged by the contact mode atomic force microscopy (AFM), in air. Chemically stabilized pericardium is used as a tissue-derived biomaterial in various fields of the reconstructive and replacement surgery. Collagen type I is the main component of the fibrous layer of the pericardium tissue. In this study, the surface topography of collagen fibrils in their native state in tissue and after chemical stabilization with different cross-linking reagents: glutaraldehyde (GA), dimethyl suberimidate (DMS) and tannic acid (TA) was investigated. It has been found that chemical stabilization causes considerable changes in the surface topography of collagen fibrils as well as in the spatial organization of the fibrils within the tissue. The observed changes in the D-spacing pattern of the collagen fibril correspond to the formation of intrafibrilar cross-links, whereas formation of interfibrilar cross-links is mainly responsible for the observed tangled spatial arrangement of fibrils and crimp structure of the tissue surface. The crimp structure was distinctly seen for the GA cross-linked tissue. Surface heterogeneity of the cross-linking process was observed for the DMS-stabilized tissue. SDS-PAGE electrophoresis was performed in order to evaluate the stabilization effect of the tissues treated with the cross-linking reagents. It has been found that stabilization with DMS, GA or TA enhances significantly the tissue resistance to SDS/NaCl extraction. The relation between the tissue stability and changes in the topography of the tissue surface was interpreted in terms of different nature of cross-links formed by DMS, GA and TA with collagen.

Animals↗
PubMed2003

Pericardium modulates left and right ventricular stroke volumes to compensate for sudden changes in atrial volume.

The pericardium may modulate acute compensatory changes in stroke volumes seen with sudden changes in cardiac volume, but such a mechanism has never been clearly demonstrated. In eight open-chest dogs, we measured left and right ventricular pressures, diameters, stroke volumes, and pericardial pressures during rapid (approximately 300 ms) systolic infusions or withdrawals of approximately 25 ml blood into and out of the left atrium and right atrium. Control beats, the infusion/withdrawal beat, and 4-10 subsequent beats were studied. With infusions, ipsilateral ventricular end-diastolic transmural pressure, diameter, and stroke volume increased. With the pericardium closed, there was a compensatory decrease in contralateral transmural pressure, diameter, and stroke volume, mediated by opposite changes in transmural end-diastolic pressures. The sum of the ipsilateral increase and contralateral decrease in stroke volume approximated the infused volume. Corresponding changes were seen with blood withdrawals. This direct ventricular interaction was diminished when pericardial pressure was <5 mmHg and absent when the pericardium was opened. Pericardial constraint appears essential for immediate biventricular compensatory responses to acute atrial volume changes.

Animals↗
PubMed1986

In vivo mechanical behavior of canine pericardium.

We examined the in vivo mechanical behavior of the pericardium by measuring simultaneous atrial and intrapericardial pressures and mutually orthogonal, circumferential, and longitudinally oriented pericardial segment lengths (ultrasonic gauges) in 10 open-chest dogs. Venous return was varied by a combination of caval occlusion followed by volume loading. Up to a mean left atrial pressure of 25 mmHg, the pericardium lengthened virtually exclusively in the circumferential direction (n = 9). Thus, at an intrapericardial pressure of 6.0 +/- 1.0 (+/- SD) mmHg, circumferential strain (normalized to length at pericardial pressure 0 mmHg) was 0.30 +/- 0.28, whereas longitudinal strain was 0.02 +/- 0.06 (P less than 0.05). In five of these dogs, alteration of external pericardial loading by severing the pericardial diaphragmatic attachments did not change the difference between circumferential and longitudinal strain, and in two the same directional strain difference was observed during production of cardia tamponade. In three additional dogs the square of the circumferential segment length was closely correlated with the directly measured intrapericardial volume when saline was infused into the pericardial space in an in situ, arrested heart preparation. Our results indicate that there is marked directional variability in lengthening of the pericardium when the volume of its contents is altered in vivo. This phenomenon is probably the result of complex interactions between the properties of the pericardial tissue and the influence of its internal and external loads.

Animals↗
PubMed1987

Quantification of effect of pericardium on LV diastolic PV relation in dogs.

The aim of the present study was to quantify the effect of the pericardium on the left ventricular (LV) diastolic pressure-volume relation. The experiments were done in 10 anesthetized closed-chest dogs. Pericardial and cardiac volumes were determined by computed tomography. Pericardial effusion (n = 5) and volume loading (6% dextran iv; n = 5) were used to increase pericardial volume. Volumes were normalized as multiples of the LV volume measured when LV transmural pressure was 6 mmHg (VLV6). Using the data from the pericardial effusion experiments, we calculated the best-fit exponential equations for the pericardial pressure-volume relations. From these equations we calculated that the changes in pericardial volume necessary to shift the LV diastolic pressure-volume curve upward by 2, 5, 10, and 20 mmHg were 0.6 +/- 0.1, 1.1 +/- 0.2, 1.6 +/- 0.2, and 2.2 +/- 0.3 times VLV6, respectively. Using the data from the volume loading experiments, we also calculated the degree of upward shift of the LV pressure-volume relation caused by volume loading, which increased LV mean diastolic pressure by 12 mmHg. (The upward shift is that increment in pericardial pressure caused by the total increase in volume of the extra-LV contents of the pericardium, i.e., the atria, the right ventricle, and any pericardial effusion.) This volume loading increased the total volume of the right ventricle and the atria by 1.0 +/- 0.1 VLV6, which, in itself, increased pericardial pressure by 3.6 +/- 0.8 mmHg. We conclude that in situations in which heart or pericardial volume increases acutely, the pericardium shifts the diastolic pressure-volume relation of the LV upward by a significant amount.

Animals↗