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At least 19 recordsLinked to original sources
PubMed1976

Closure of pericardium after open heart surgery. A way to prevent postoperative cardiac tamponade.

Between July 1968 and December 1975, 821 patients underwent open heart operations. In 596 cases the pericardium was left open and in 225 the pericardium was closed. Forty-one patients in the open pericardium group required reoperation and 23 of these had tamponade. Four patients in the closed pericardium group had reoperation but there was not a single case of tamponade. In most cases that required reoperation the bleeding was from extrapericardial sources. Absence of tamponade in the closed pericardium group can be explained by the fact that blood from extrapericardial sources of bleeding cannot collect round the heart because the pericardium is closed. Thus closure of pericardium helps to prevent tamponade. Reoperations some months or years after the original operation are technically easier and less hazardous if the pericardium has been closed because the closed pericardium prevents the heart from becoming adherent to the back of sternum and also because there are fewer adhesions in the pericardial cavity.

Cardiac Surgical Procedures↗
PubMed1978

Heterologous pericardium for the closure of pericardial defects.

Patches of glutaraldehyde-preserved porcine pericardium were transplanted orthotopically into 20 dogs to see if they might make a satisfactory pericardial substitute. Two dogs had mediastinal infections and were excluded from this study. All animals were reoperated on at regular intervals between 15 and 300 days. In 15 dogs there were no adhesions between the porcine pericardium and the host's epicardium. Histological study showed healing between both pericardiums and no degenerative changes in transplanted pericardium. Glutaraldehyde porcine pericardium has been utilized in 8 patients to close the pericardial cavity. There have been no problems related to the pericardial grafts after a maximum follow-up of 9 months.

Adult↗
PubMed1976

Should the pericardium be closed after an open-heart operation?

A controlled clinical study was carried out to decide whether the pericardium should be left open or closed after open-heart operations. One hundred patients had the pericardium closed with interrupted silk, another 100 had the pericardium left open. Complications were alike except for the more frequent occurrence of a pericardial rub in the closed group (14 vs 3 patients), though the incidence of post-pericardiotomy syndrome was equal. There was no late tamponade. Two early reexplorations for bleeding were done in the open group, none in the closed. There were no postoperative deaths. In the patients who consented to postoperative angiography following revascularization procedures, the incidence of graft failure was equal in both groups. The pericardium should be closed after an open-heart operation. Morbidity and mortality are unchanged, and repeat cardiac exploration is safer.

Aortic Aneurysm↗
PubMed1975

Influence of primary closure of the pericardium after open-heart surgery on the frequency of tamponade, postcardiotomy syndrome, and pulmonary complications.

Experiences with primary closure of the pericardium in a series of 100 patients undergoing open-heart operations are described. The pericardium was kept under tension during the operation to minimize shrinkage and permit closure at the end of the procedure. In 28 patients one pleural space was opened for drainage, whereas in 72 patients intra- and extrapericardial sumps alone were used for drainage. Measurements of sump drainage revealed that most postoperative bleeding originates from outside the pericardium. There were no instances of cardiac tamponade although 19 patients lost more than 1 L. of blood after operation and 5 required reoperation for hemorrhage. Transpleural drainage tubes were shown to be ineffective and in addition were associated with a fourfold increase in postcardiotomy syndrome and a significantly greater frequency of pleural effusion and atelectasis when compared to the use of mediastinal sump drainage alone. We have concluded that closing the pericardium and using mediastinal sump drainage minimizes the risk of cardiac tamponade and allows early localization of the site of postoperative bledding. Another advantage of pericardial closure and drainage is that postoperative adhesions and postcardiotomy syndrome will be less significant. As a consequence the danger of injuring the heart in a subsequent operation is lessened.

Adult↗
PubMed1978

A case report of surgical repair of traumatic rupture of the pericardium and diaphragm.

A 55 year-old male with traumatic rupture of the pericardium, diaphragm and spleen, and with crush of the pancreas was successfully operated upon. The diagnosis of rupture of the diaphragm was done on the chest X ray on admission, and the rupture of the pericardium was diagnosed at the time of laparotomy and thoracotomy. The ruptured spleen and the crushed pancreas tail were removed, and the ruptured pericardium and diaphragm were closed successively.

Accidents, Traffic↗
PubMed1975

Thymoma masquerading as congenital partial absence of the left pericardium.

Interpretation of irregularities of the left heart border on routine posterior-anterior and lateral roentgenograms may be quite challenging. Partial absence of the left pericardium provides a characteristic abnormality of the left heart border. Described is a case of a thymoma which mimicked partial absence of the left pericardium on routine roentgenography. The importance of including both partial absence of the left pericardium and thymoma in the differential diagnosis of irregularities of the left heart border is discussed.

Adult↗
PubMed1975

Mathematical and mechanical modeling of stress-strain relationship of pericardium.

Several mathematical expressions (models) were compared for use in describing the stress-strain (sigma - epsilon) relationship of pericardium. The expression sigma = alpha[ebeta epsilon - 1] was preferred because of its simpler form, theoretical consistency, and "good fit" of experimental data. A method was developed for estimating the precisions of the estimates of the parameters alpha and beta. This approach can have general usefulness in assessing the significance of a change in stress-strain relationship of various soft tissues following different interventions. A mechanical model was formulated for the pericardium which consisted of springs representing the collagen and elastin fibers connected in parallel. It could be simulated by the above equation and could describe the behavior of the pericardium.

Elasticity↗
PubMed1976

Echocardiography in congenital and acquired absence of the pericardium. An echocardiographic mimic of right ventricular volume overload.

The purpose of this study was to investigate the echocardiographic effects of absence of the pericardium. Five patients with congenital complete absence of the left pericardium were studied. All had typical chest X-rays, four had cardiac catheterization which excluded any intracardiac shunts, and one had diagnostic pneumothorax. All five had an enlarged right ventricular dimension (RVD): 1.9 +/- 0.1 cm/m2 (normal: less than 1.3 cm/m2) and abnormal interventricular septal (IVS) motion (three Type A, two Type B). Sixteen additional patients were studied after pericardial stripping for a variety of conditions. In none was cardiopulmonary bypass used. Eight of these patients had preoperative echocardiograms; all showed normal IVS motion. After surgery RVD was large in all 16 patients, increasing from 1.0 +/- 0.2 cm/m2 preoperatively to 1.7 +/- 0.1 cm/m2 postoperatively, P less than 0.01. Fourteen of the 16 patients had abnormal IVS motion, nine Type A, and five Type B. We conclude that absence of the pericardium results in echocardiographic abnormalities which mimic those seen in right ventricular volume overload. This may be due to altered cardiac position and motion within the thorax resulting from loss of normal pericardial restraint.

Cardiomegaly↗
PubMed1978

Alteration of the left ventricular diastolic pressure-segment length relation produced by the pericardium. Effects of cardiac distension and afterload reduction in conscious dogs.

Left ventricular pressure and segment length were measured in seven conscious chronically instrumented dogs with the pericardium intact and 3-9 days after pericardiectomy. Diastolic pressure-length plots were obtained under control conditions and after acute volume loading followed by sodium nitroprusside infusion. In all dogs with intact pericardium, volume loading displaced the entire diastolic pressure-length curve upwards and sodium nitroprusside shifted it toward control. After pericardiectomy the pressure-segment length data during control, volume loading and sodium nitroprusside fell on a single curve (intercepts and slopes not statistically different); After dextran infusion, intrapericardial pressure rose from control 1.5 +/- 0.7 mm Hg to 8.2 +/- 0.5 mm Hg, and it fell to 4.8 +/- 0.1 mm Hg after nitroprusside. Therefore, in acute cardiac dilatation the pericardium contributed significantly to the increased left ventricular diastolic pressure and to the fall during sodium nitroprusside infusion and appeared responsible for shifts in the diastolic pressure-segment length relation.

Animals↗
PubMed1976

[Congenital defects of the left-sided pericardium].

Three patients with congenital absence of the left pericardium and one patient with a partial left pericardial defect are described. Congenital absence of the left pericardium is characterized roentgenologically by levoposition of the heart, a prominent pulmonary artery segment and cardiac apex, interposition of lung between the left hemidiaphragm and the base of the heart, and unusual mobility of the heart. The electrocardiogram frequently shows right axis deviation, an incomplete right bundle branch block and leftward displacement of the transition zone in the precordial leeds. The anomaly has often been mistaken for other heart disease. As an isolated anomaly it is benign and does not require any treatment. Patients with a partial defect of the left pericardium can only be diagnosed lcinically if the left atrial appendage herniates through the defect. The herniation produces a protruding shadow along the left heart border and can be demonstrated angiographically and by fluoroscopy. In isolated cases death caused by herniation and strangulation of larger parts of the heart through a partial left pericardial defect has been described.

Adolescent↗
PubMed1975

Congenital partial absence of the left pericardium.

A 38 year old woman with congenital partial absence of the left pericardium is presented. The condition is fairly rare, usually diagnosed incidentally during intrathoracic operations or at autopsy. Eleven operatively corrected cases are reported in the literature. The present case was admitted because of transient attacks of chest pain, palpitation and dyspnoea. These attacks were brought on when she lay on her left side and were promptly relieved by a change of position. The chest radiograph revealed a prominence of the superior aspect of the left heart border and a slight laevo-position of the heart. A diagnostic pneumothorax on the left side confirmed the diagnosis of a pericardial defect. The defect was repaired by pericardioplasty. Operative correction of a partial left pericardial defect is indicated because of the danger of luxation of the heart out of the pericardium and sudden death. This has been reported, as well as a death caused by spreading of infection from the pleural cavity into the pericardium and heart.

Adult↗
PubMed1978

A mechanism for shifts in the diastolic, left ventricular, pressure-volume curve: the role of the pericardium.

Attempts to explain acute shifts in the pressure-volume relationship by changes in myocardial stiffness have been unsupported by animal experimentation and discouraged by calculations showing that making half the ventricle rigid would hardly account for the clinically observed upward shifts in the curve. Data collected in open-chest anesthetized dogs during volume loading with the pericardium open and closed indicate that when the pericardium is closed, left ventricular enddiastolic pressure is better predicted by right ventricular pressure than by left ventricular dimensions. These data support the hypothesis that acute, upward shift in the pressure-volume curve may be caused by an increase in pericardial pressure, in turn caused by an increase in the volume of the intrapericardial contents. This follows from the fact that measured left ventricular diastolic pressure is equal to the sum of the pressure differences accross the myocardium and the pericardium. Thus, increases in pericardial pressure raise measured ventricular diastolic pressure without change in ventricular volume: hence, an upward shift in the pressure-volume curve.

Animals↗
PubMed1975

Radiologic patterns of congenital malformations of the pericardium.

Various congenital malformations of the pericardium are describe. The defects of the pericardium are considered, which are more often partial and on the left side than total. Diagnosis is based on angiography and diagnostic pneumothorax. The pleurocardial cysts are frequent and diagnosed on plain films with pneumoperitoneum. The intrapericardial teratoma are seldom. Diagnosis is made on angiocardiography with pneumopericardium. Radiology is very useful for the diagnosis of various types of congenital malformations of the pericardium.

Adolescent↗
PubMed1979

Biosynthesis of prostaglandin (PGI2) and 12L-hydroxy-5,8,10,14-eicosatetraenoic acid (HETE) by pericardium, pleura, peritoneum and aorta of the rabbit.

Prostacyclin generation by pericardium, pleura, peritoneum, aorta and dura mater of the rabbit was assessed as platelet aggregation inhibitory activity in platelet rich plasma. All tissues except the dura mater, were also incubated with labelled (1-14C) arachidonic acid and (1-14C) prostaglandin endoperoxide H2 and the various metabolites formed were identified radiochromatographically. Pericardium, pleura and peritoneum form substantially high amounts of prostacyclin and HETE indicating that these tissues contain both cyclo-oxygenase and prostacyclin-synthetase. They also show considerable lipoxygenase activity.

Animals↗
PubMed1976

Angiosarcoma of pericardium. Problems in diagnosis and management.

The clinical histories of two patients with angiosarcoma of the pericardium are described. Both were previously well young men who presented with cardiac tamponade caused by haemorrhagic pericardial effusions. If a pericardiectomy is undertaken for diagnosis, wide excision of the pericardium is recommended. This will provide a large specimen for histological examination and may prevent subsequent development of constriction.

Adult↗
PubMed1978

Malignant mesothelioma arising after direct application of asbestos and fiber glass to the pericardium.

A case of mesothelioma, apparently arising in the pericardium, is reported in a patient who, 15 years previously, had been treated for angina pectoris by dusting of the pericardial cavity with a mixture of fibrous dusts. At autopsy, transparent fibers and ferruginous bodies were present within the pericardium. Electron diffraction and microprobe analysis indicated that approximately two thirds of the fibers were tremolite and anthophyllite asbestos, and the remainder, fiber glass. Development of mesothelioma in laboratory animals has been reported after intrapleural deposition of asbestos and other fibers, but in humans, the link between exposure to asbestos and mesothelioma has always been based on epidemiologic data and the retrospective finding of asbestos in tissues. To our knowledge, this is the first example of a malignant mesothelioma in a human associated with direct mesothelial contact with fibrous dusts.

Angina Pectoris↗
PubMed1975

[Thoracic gunshot-injury with penetration of the pericardium in a 15-year-old student].

On account of the exceptionality is reported on a 15-year-old adolescent who suffered a gunshot into the thorax by a device which was built by himself. More than 12 hours after the accident for the first time a physician was consulted. Then the patient was transported to Leipzig for operation. The missile had penetrated the anterior wall of the pericardium, had passed through the cleft between exterior layer of the myocardium and the pericardium and lodged at the trangression into the adjacent lung. The postoperative course was without complications. The patient could be dismissed without any complaints.

Adolescent↗