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PubMed2000

Is 10 minutes the optimum immersion time in 0.6% glutaraldehyde for human pericardium?

BACKGROUND AND AIM OF THE STUDY: Pericardial fixation with 0.6% glutaraldehyde is usually assessed by measuring the shrinkage temperature of the tissue: the higher the shrinkage temperature, the greater the degree of cross-linking induced between collagen molecules. Animal pericardium studies have shown maximum response to be obtained after brief immersion (10 min). Our aim was to evaluate the effect of glutaraldehyde immersion time on shrinkage temperature of human pericardium which, to our knowledge, has not yet been studied. METHODS: Pericardial strips were harvested from 40 patients undergoing cardiac surgery. Time of immersion in glutaraldehyde ranged from 3 min to 6 months. Fresh untreated human pericardium samples were used as controls. The relationship between shrinkage temperature and time of treatment with glutaraldehyde was studied using a regression analysis. RESULTS: Glutaraldehyde treatment of pericardial tissues caused an increase in shrinkage temperature that was related biphasically to the time of immersion in glutaraldehyde. Mathematical expression of this curve permitted glutaraldehyde immersion time to be evaluated in relation to the degree of optimal shrinkage temperature. The time required for optimal fixation with glutaraldehyde, as measured by shrinkage temperature, was 100+/-0.77 min. CONCLUSION: Our results suggested that a 10-min exposure to glutaraldehyde was insufficient for 'correct' fixation of human pericardium. Inadequate glutaraldehyde exposure of human pericardium may explain mid and long-term failures reported with this tissue in cardiac surgery.

Bioprosthesis↗
PubMed2001

[Abnormalities of the pericardium].

By 2000 there have been at least 187 cases of rare pericardial malformations (of them there were 5 cases of the authors) and 1047 cases of celomic pericardial cysts (CPC) (43 cases of the authors) in the literature. Of them 18 (9.6%) patients were found to have no pericardium, the absence of its left half was in 76 (40.6%). No left pericardium was more common in men (61.04%) than in women (38.96%). The literature reports about the absence of the right pericardium only in one case. Partial pericardial defects were encountered in 30.48% of patients with rare pericardial malformations. In general, malformations in the left pericardium were 10 times more common often than those in the right one. The absence of the pericardium or its half most commonly requires no surgical correction. In partial defects, suturing or plastic closure must be performed due to a risk for strangulation and a possible fatal outcome. CPC are not clinically manifested in more than 50% of the patients with CPC, but in some cases dyspnea, dry cough, palpitation may be caused by other causes. Cystectomy yields good results.

Adolescent↗
PubMedDate not supplied

Treatment of scleral melt associated with uveal prolapse by pericardium grafting in Wegener's granulomatosis.

PURPOSE: To report the use of preserved pericardium tissue in the treatment of scleral melt associated with uveal prolapse secondary to Wegener's granulomatosis. Wegener's granulomatosis may initially present with ophthalmic findings including scleral melting with uveal prolapse. In order to preserve the globe and treat this potentially fatal disease, prompt diagnosis, surgical correction of uveal prolapse, and subsequent immunosuppressive therapy are imperative. If advanced scleral melt associated with uveal prolapse is present, pericardium grafting with conjunctival advancement is a useful technique. METHODS: Case report of a 70-year-old white female who initially presented with a unilateral sderal melt associated with uveal prolapse involving 6 clock hours of the surgical limbus. Emergent pericardium grafting of the involved limbus with conjunctival advancement performed to correct the endangered globe. Laboratory data including sedimentation rate, cANCA, computerized tomography of the chest, and urinalysis confirmed the diagnosis of Wegener's granutomatosis. RESULTS: After pericardium grafting and immunosuppressive therapy the patient returned to baseline visual acuity, the sedimentation rate normalized, and the pulmonary lesions and renal failure resolved. The patient has been followed for 3 years since the initial diagnosis of Wegener's granulomatosis and there has been no recurrence. CONCLUSIONS: To the best of the author's knowledge, this is the first report using processed pericardium to emergently treat scleral melt associated with uveal prolapse, thereby allowing preservation of the globe. In addition to management of the scleral melt, systemic evaluation and treatment with immunosuppressive therapy are necessary.

Aged↗
PubMed1992

[A study of immunocompetence of peptide hormones in human pericardium].

With RIA/HPLC and immunohistochemistry, the presence of angiotensin(A) and atrial natriuretic factor-like materials (ANF-LMs) was demonstrated in the pericardium of human and rats; the distributions of AII and ANF-LMs were found to be identical; AI was more than AII; renin activity was detected in the pericardium. There were three molecular forms of ANF-LMs in the pericardium. Mesothelial cells were the principal endocrine-secreting cells. AII and ANF-LMs of the pericardium were significantly increased in rheumatic heart disease. There were no correlations between plasma AII, ANF, urine AII, ANF and pericardial AII, ANF (P > 0.05). The data reported showed that the pericardium may have endocrine function under normal and abnormal conditions (heart failure) of the heart, in addition to its known mechanical properties.

Angiotensin II↗
PubMed1992

[The functional expectations of valve bioprostheses. I. Physical and histopathological tests for the use of sections of bovine pericardium].

PURPOSE: The heterogenicity of the bovine pericardium sac regarding its elasticity, extensibility and thickness encouraged the work with the purpose to study the different areas of pericardium, mapped according to its position on the heart. METHOD: Ten bovine pericardium sacs previously selected and obtained at the slaughterhouse immediately after the animal slaughter were utilized. The pericardia were sectioned sagittally from the anterior to the posterior portion, thus obtaining two parts, right and left. Two areas were demarcated for each one of them amounting to four regions: A, B, C and D. Each of the four regions was divided into two regions: 1 and 1, amounting to 80 samples. There have been physical tests (shrinkage and mechanical resistance), histopathological studies and statistical analysis were done. RESULTS: The right ventricle area (region D) had the best utilization (21.3%), and then the left ventricle area (region B, 16.2%). The physical tests on the utilized samples showed minimum and maximum values of 0.20 and 0.40 mm for the thickness, 2.0 and 7.0 kgf for force, 1.6 and 4.2 kgf/mm2 for rupture, 18 and 36% for stretching, 15 and 65 for tenacity index and 85 and 87 degrees C for shrinkage. The region D presented histologically and more preserved, either for the collagen fibers or the elastic ones. CONCLUSION: The results of the statistical analysis proved the need to increase the sample size to certify the existence of a sectioning of the pericardium and a more adequate position of the proof body (longitudinal, transversal and oblique) when obtaining the pericardium flap to make the valve bioprosthesis.

Animals↗
PubMed2006

[Experience of surgical treatment of the heart and pericardium wounds].

Results of treatment of 120 injured persons with the heart and pericardium wounding were analysed. Issues of diagnosis and treatment of the heart and pericardium wounding were reviewed. Efficacy of treatment of the heart and pericardium wounding depends on the time gap between the trauma moment and the specialized surgical aid delivery. Diagnostic measures for the possible heart and pericardium wounding ought to be minimal. The established heart and pericardium wounding diagnosis, and sometimes the possibility of such wounding, constitute indication for performance of urgent operative intervention. All the heart woundings must be sutured and pericardial cavity drained.

Adolescent↗
PubMed1991

[A case of complete absence of the left pericardium coexisting with straight back syndrome].

A case of complete absence of the left pericardium coexisting with straight back syndrome in a 30-year-old female is presented. She had been asymptomatic, but was referred to our hospital because of an abnormal finding on a chest X-ray obtained during a routine physical examination. The posteroanterior view of the chest X-ray showed displacement of the right and left cardiac border to the left and bulging of the left cardiac border. The lateral view showed loss of normal thoracic curvature and also demonstrated the straight back syndrome. Echocardiography showed paradoxical movement of the ventricle septum, hyperkinetic movement of the free wall of the left ventricle and enlargement of the right ventricle. Computed tomography and magnetic resonance imaging with an artificial pneumomediastinum clearly showed rotation of the heart into the left hemithorax, prominence of the pulmonary trunk and pneumopericardium. Hence the diagnosis of the complete absence of the left pericardium coexisting with straight back syndrome was made. Congenital defect or absence of the pericardium are rarely reported. Only about 120 cases have been described in Japan. Only a few cases have been diagnosed antemortem. Most of them were found by chance during operations or on installation of an artificial pneumothorax. We suggest that an artificial pneumomediastinum as well as a pneumothorax is useful for the diagnosis of the absence of the pericardium. This is the first reported case of a complete absence of the left pericardium coexisting with straight back syndrome.

Adult↗
PubMed1991

Calcification of chemically treated bovine pericardium.

One of the most important problems arising in cardiac bioprostheses made with bovine pericardium and, more generally, with biologically-derived tissues is tissue calcification. The present study assessed four chemical treatments on patches of bovine pericardium, intended to avoid or minimize calcification. Pericardium specimens were treated with: A) 0.5% glutaraldehyde; B) 0.5% glutaraldehyde + 4% formaldehyde; C) same as A, but with a further neutralization treatment; D) acylation of fresh bovine pericardium. Circular samples of 1 cm diameter were subcutaneously implanted in the abdominal region of three groups of six rats. The explants were retrieved after 2, 4 and 8 weeks. The calcium content and the histological results showed better behaviour for C and D samples than with the commonly used fixation methods (A and B). The lowest calcification was observed with treatment D, even though its morphological structures were somewhat modified with homogenation of collagen bundles. Among the glutaraldehyde-based treatments, treatment C appears to be the most promising because the pericardium shows slower calcium accumulation with a diffusive pattern.

Animals↗
PubMed1990

Influence of the pericardium and ventricular interdependence on left ventricular diastolic and systolic function in patients with heart failure.

The pericardium, because of the nature of its pressure-volume relation, can influence left ventricular diastolic and systolic pump function. During an acute increase in heart size that results in the stretching of the pericardium, the elastic properties of the pericardium restrict further cardiac dilatation and curtail the ability of the ventricles to increase stroke volume. In addition, the pericardium enhances the degree to which increments in right ventricular volume would alter left ventricular diastolic distensibility. Ventricular interdependence is enhanced as a direct consequence of pericardial elastic properties. During the heightened venous return associated with marked muscular work, we found evidence of pericardial constraint in 31 of 61 patients with heart failure of varying severity and diverse etiology. The occurrence of pericardial constraint, which was characterized by stroke volume becoming invariant and an equivalent rise in right atrial and pulmonary capillary wedge pressures as work load was raised during incremental upright exercise, was independent of the degree to which maximum oxygen consumption was reduced or, equivalently, the severity of heart failure. In contrast, when pericardial constraint was not apparent during our exercise protocol, stroke volume did not become invariant, and the increments in pulmonary capillary wedge pressure were two- to threefold that of right atrial pressure. Thus, the pericardium can have a substantial role in determining the limits to left ventricular diastolic and systolic function.

Exercise↗
PubMed1986

Calcification of bovine pericardium used in cardiac valve bioprostheses. Implications for the mechanisms of bioprosthetic tissue mineralization.

Calcification of bioprosthetic heart valves fabricated from glutaraldehyde-pretreated bovine pericardium has not been investigated. The objectives of this study were to characterize pericardium before and after glutaraldehyde pretreatment and to study the pathophysiology of mineralization of glutaraldehyde-preserved pericardium. Pericardial protein was approximately 90% collagen, predominantly Type I. Glutaraldehyde incorporation was complete following 24 hours' incubation (151 X 10(-9) mol/mg). Bovine pericardium pretreated in buffered 0.6% glutaraldehyde, implanted subcutaneously in young rats for 24 hours to 112 days, was analyzed chemically (calcium and phosphorus) and morphologically. Mineralization, detected at 48 hours' implantation, was initially associated with pericardial connective tissue cells and later also collagen. Mean calcium content was 114 micrograms/mg at 21 days and 199 micrograms/mg at 112 days. The morphologic features and the kinetics and degree of mineral accumulation in glutaraldehyde-pretreated bovine pericardium were strikingly similar to those previously determined for porcine aortic valve. These results predict that calcification will critically limit the late durability of clinical pericardial bioprostheses and suggest generalized mechanisms of bioprosthetic tissue mineralization which are probably dependent on modification of implant microstructure by glutaraldehyde pretreatment.

Amino Acids↗
PubMed1986

[Postural effects in the jugular phlebogram in patients with complete absence of the left pericardium].

To elucidate the function of the pericardium, alterations in jugular phlebograms, intracardiac pressures and cardiac volumes induced by postural changes were examined in seven patients with complete absence of the left pericardium. Ten patients with ischemic heart disease were studied as controls. Jugular phlebograms in patients with complete absence of the left pericardium showed decreased depths of the x descent and the tall v waves followed by the deep y descents (M-shaped pattern) in the supine position. These jugular abnormalities were exaggerated in the left lateral decubitus position. By contrast, the jugular phlebograms tended to return to normal, but remained abnormal in the right lateral decubitus position. Right atrial pressure curves showed similar postural effects. However, the jugular phlebograms and right atrial pressure curves in patients with ischemic heart disease were not altered by postural changes. The characteristic alterations of the jugular phlebograms are useful indicators for diagnosing complete absence of the left pericardium. The lack of a prompt decrease in pericardial pressure during ventricular ejection due to the absence of the pericardium is one of the causes of a decreased depth of the x descent in pericardial defect. However, this cannot explain the postural alteration of the jugular phlebogram. Another possible mechanism is the decreased excursion of the tricuspid ring during systole. As indicated in our previous report, there is anterior movement of the cardiac apex during systole in cases of pericardial defect, which is exaggerated in the left lateral decubitus position and decreased in the right lateral decubitus position due to the lack of normal pericardial support. This anterior swinging motion may inhibit the descent of the tricuspid ring toward the apex, resulting in a decreased depth of the x descent of the jugular phlebogram and the right atrial pressure curve and their postural alterations. The right ventricular volume as calculated from cardiac computerized tomography and the right ventricular end-diastolic pressure were not altered significantly by postural changes in the control cases. These indices increased to a greater extent in the left lateral decubitus position than in other postures in cases with pericardial defects.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

[Pericardial defect: roles of the pericardium on kinetoanatomic changes of the heart influenced by patients' postures].

To elucidate the physioanatomic roles of the pericardium, the alterations in gross anatomy and cardiac motion induced by posture were examined by two-dimensional echocardiography in seven patients with total absence of the left pericardium. Ten healthy subjects were served as controls. The heart was located deeper within the chest at end-diastole in patients with pericardial defect than in healthy subjects, especially in the left lateral decubitus position. With progression of systole, the cardiac apex swung anteriorly with the cardiac base as the fulcrum, and the heart approximated the normal position at end-systole. The deeper the position of the center of the cross-section of the left ventricular cavity at end-diastole, the more exaggerated the swinging motion in systole. The deep location of the heart in end-diastole is considered to result from release from pericardial support, and the systolic tonus of the cardiac muscle restores the apex to nearly normal position. The characteristic swinging motion of the heart and its alterations dependent of posture seemed the signs suggestive of total absence of the pericardium. The shape of the short-axis view of the left ventricular cavity was nearly circular throughout the cardiac cycle. Therefore, paradoxical motion of the ventricular septum observed on M-mode echocardiography in pericardial defect results from the anterior shift of the entire heart overcoming the proper motion of the interventricular septum. The left ventricular dimension become enlarged according to the postural change from the right to left lateral decubitus positions regardless of the presence or absence of the pericardium. The right ventricular cavity became enlarged in the left lateral decubitus position in patients with pericardial defect. The elevation of hydrostatic pressure due to postural change was considered excessive due to the absence of the pericardium. In the left lateral decubitus position, systolic excursions of the mitral and tricuspid rings became more prominent in healthy subjects, whereas these excursions, particularly of the tricuspid ring, were reduced in patients with pericardial defect. Depressed tricuspid ring motion was also observed in the right lateral position in cases with pericardial defects. The reduced excursion of the tricuspid, ring and the right ventricular dilatation may affect systemic venous return to the right atrium.

Adult↗
PubMed1986

Comparative electron microscopic study of bovine, porcine and human parietal pericardium, as materials for cardiac valve bioprostheses.

Light, scanning and transmission electron microscopy were used in the comparison of bovine, porcine and human parietal pericardium. Bovine pericardium is widely used for heart valve bioprosthesis, is thicker than the other two, and has more coarse connective tissue fiber components, whereas porcine pericardium possesses relatively larger quantities of fat cells in regular layers. Human tissue is thinner than either the bovine or porcine parietal pericardium and its mesothelium seems less delicate. The human tissue, being thinner, may provide a source of materials for valves with significant hemodynamic characteristics. Such material might be used to produce small diameter valves directed towards younger patients. Though the literature does not mention its usage, porcine pericardium is of intermediate thickness and it too may serve in the future as a construction material for valve bioprostheses.

Adipose Tissue↗
PubMed1984

Ultrastructure of the parietal pericardium in teleosts.

The ultrastructure of the parietal pericardium in Melanogrammus aeglefinus, Paracheirodon innesi, and Poecilia reticulata is described in larvae of variable age. This structure is composed of a mesothelial layer facing the pericardial cavity and an outer layer of collagen tissue. The latter is continuous with the surrounding tissue, i.e. mainly skeletal muscles. Generally, the parietal pericardium is attached to loose connective tissue dorsally, whereas its ventral and lateral parts are connected to muscles and tendons. Posteriorly, it is fused with the peritoneum. In prenatal larvae of P. reticulata the parietal pericardium is in contact with yolk material. The parietal mesothelial cells are attenuated and contain numerous ribosomes, a well developed Golgi apparatus, and a number of membrane-bound inclusion bodies (0.1-0.4 micron) of moderate electron density. In addition, numerous pinocytotic vesicles (80-100 nm) occur in differentiated mesothelial cells, whereas they are scarce in undifferentiated cells. Furthermore, bristle-coated vesicles are very rare in differentiated mesothelial cells, whereas they are seen regularly in undifferentiated cells. The collagen fibre bundles of the parietal pericardium are often orientated perpendicularly to each other, and in postnatal larvae of P. reticulata a one cell thick layer of melanophores occurs within the fibrous tissue. These cells contain numerous membrane-bound, highly electron-dense inclusion bodies (0.3-0.6 micron). They are occasionally seen in Paracheirodon innesi also, whereas they are absent in 2 and 6 days old larvae of M. aeglefinus and prenatal larvae of P. reticulata. Macrophages, capillaries, and nerve bundles occur in the pericardial and subpericardial connective tissue. The present results are discussed and compared with those previously reported for mammalian parietal pericardium.

Animals↗
PubMed1995

The lymphatic drainage of the parietal pericardium in man.

Parietal pericardial lymphatics were visualized by indirect and direct India ink injections in 35 human cadavers. Studies included examination of cleared specimens under the dissecting microscope and standard light microscopy. The lymphatic vessels of the ventral pericardial surface most often pass along the phrenic nerves cranially to terminate in the anterior right and left and transverse mediastinal nodes, or caudally to the diaphragm or prepericardial lymph nodes. The lymphatics draining the lateral parts of pericardium pass to the anterior mediastinal, tracheobronchial, lateropericardial, prepericardial and posterior mediastinal (juxtaesophageal) lymph nodes. The posterior part of the pericardium drains to the juxtaesophageal and tracheobronchial nodes. Lymphatics from the diaphragmatic part of the pericardium pass to the right lateropericardial and prepericardial, juxtaesophageal and tracheobronchial nodes. The pericardial cupula is anteriorly drained to the anterior mediastinal nodes, and posteriorly to the tracheobronchial nodes. In cleared specimens two networks of lymphatic vessels are seen to surround the pericardial space. On the ventral surface, the lymphatics of the parietal pericardium connect to lymphatics in the pericardial fat and areolar tissue. On the lateral and posterior surfaces, the lymphatics of the parietal pericardium anastomose with lymphatics of the reflected mediastinal pleura. These anatomical observations offer new insights into the mechanisms of turnover of pericardial fluid and into the mechanisms of occurrence of chylopericardium.

Adolescent↗
PubMed1996

An autopsy case of malignant lymphoma with a high serum CA 125 level occurring only in the brain and pericardium.

We report an autopsy case of a central nervous system (CNS) B-cell type lymphoma followed by cardiac tamponade. In this case, lymphoma cells which occurred primarily in the pericardium appear to metastasize to the brain and gradually increase in size in spite of control of the CNS lesion. The serum carbohydrate antigen 125 (CA 125) level was highly elevated and the autopsy findings showed the involvement of lymphoma only in the pericardium rather than the CNS, and the pericardium, not the tumor cells, was immunohistochemically positive for CA 125. Through this rare case, two things are suggested: first, the serum CA 125 level is elevated when B-cell type lymphoma infiltrates the coelomic epithelium; second, CA 125 is overproduced and secreted by the pericardium but not the lymphoma cells. Measurement of the serum CA 125 level may become a diagnostic marker for the infiltration of malignant lymphoma in the coelomic epithelium such as the pericardium, peritoneum or pleura.

Aged↗
PubMed1996

[A paradigmatic case of partial agenesis of the pericardium].

Complete or partial absence of the pericardium is an uncommon congenital abnormality. Since its first description, several cases have been reported. Although the clinical and instrumental features of this defect are well described, at present it is often overlooked. We report a case of a 19-year old boy referred to our Echocardiography laboratory because of a suspected interatrial septal defect. For this reason it has been recommended to undergo cardiac catheterization. The patient, completely asymptomatic, had a negative physical examination. The echocardiogram excluded the presence of an interatrial septal defect, but some abnormalities, regarding overall right-sided heart, were found (paradoxical interventricular septal movement, apparent right-sided heart enlargement, with unusual bulging of the apex of the right ventricle, an excessive basculant heart movement). In the absence of any other heart disease, we thought that these abnormalities reflected a congenital absence of the pericardium. Indeed, the chest X-ray showed some features, considered patognomonic for congenital absence of the pericardium (levoposition of the heart, lung interposition between the diaphragm and the base of the heart and between the aorta and pulmonary artery). Nuclear magnetic resonance study showed the absence of the pericardium in the posterior and posterolateral wall, confirming our suspicion. Furthermore, the posterior wall of the heart leaned to herniate through the pericardial defect. Since the partial absence of the pericardium can lead to severe complications, surgery was recommended. The correct diagnosis of this disease is very important because of its prognostic implications; this case represents a further contribution to the understanding of this defect.

Adult↗
PubMed1998

Comparative assessment of hepatic Glisson's capsule and bovine pericardium in heart valve bioprostheses.

BACKGROUND AND AIM OF THE STUDY: The optimal material for heart valve bioprostheses remains disputable. This investigation was initiated to compare the properties of hepatic Glisson's capsule, clinical experience of which in cardiovascular surgery is minimal, with those of bovine pericardium. METHODS: Hepatic Glisson's capsule was harvested from bull calves and used to create composite pulmonary arterial monocusp grafts and bioprostheses. Comparison of the strength and elastic properties of Glisson's capsule and bovine pericardium, as well as the hydrodynamic characteristics of valves made from these materials, was performed. Late results of operations using these materials were estimated echocardiographically. RESULTS: Although Glisson's capsule tissue is thinner than the bovine pericardium, its elasticity modulus is greater. However, the hydrodynamic characteristics of heart valves made from either tissue are similar. Moreover, valves made from Glisson's capsule have a lower systolic pressure gradient on the prosthesis and a higher effective orifice area. Composite pulmonary arterial xenopericardial grafts with a monocusp of Glisson's capsule were used in 30 patients during tetralogy of Fallot repair. Glisson's capsule was also used for tricuspid valve reconstruction and as a bioprosthesis in six patients with Ebstein's anomaly. At 1-2 years after surgery, the Glisson's capsule tissue remained thin and flexible, with no calcification. CONCLUSIONS: Although the hydrodynamic properties of hepatic Glisson's capsule and the bovine pericardium are similar, the capsule tissue is thinner and has a greater elasticity modulos. Thus, Glisson's capsule may be used for bioprosthesis construction both independently and in combination with bovine pericardium.

Animals↗