الفهرس 
ANATOMICAL CONSIDERATIONS OF THE PERICARDIUMOnly 14 pages are availabe for public view
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Abstract
T
he pericardium is a bilayered, flask-shaped sac structured of an inner visceral layer and a thick, stiff outer parietal layer, containing the heart and roots of great blood vessels.
The pericardium is not vital for life, as no major adverse consequences follow congenital absence or surgical removal of the pericardium. However, the pericardium serves many important, subtle functions. It limits overdistention of the cardiac chambers and facilitates interaction and coupling of the ventricles and atria, it prevents excessive torsion and displacement of the heart, minimizes friction with surrounding structures, and is an anatomical barrier to the spread of infection from contiguous structures.
Pericardial diseases can present clinically as acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis.
The clinical syndrome of pericarditis results from inflammation of the pericardium. It is diagnosed in approximately 0.1% of hospitalized patients and in 5% of patients admitted to the emergency department with non cardiac chest pain. .
When the identified etiology of acute pericarditis is not viral or idiopathic, management should be directed toward treating the underlying cause. Medical management for viral or idiopathic acute pericarditis has been centered on 3 major agents including NSAIDs , colchicine, and corticosteroids. .
The pericardial sac contains approximately 20 ml to 50 ml of serous fluid. Pericardial effusion defines the presence of an abnormal amount and /or character of fluid in the pericardial space and can be occur as a result of almost any pericardial disorder.
Treatment should be targeted at the etiology as much as possible, and when the effusion is associated with a systemic disease, the treatment is that of a systemic disease. Nevertheless, when diagnosis is still unclear or idiopathic, and inflammatory markers are elevated, a trial of aspirin or a nonsteroidal anti-inflammatory drug (NSAID) can be prescribed to evaluate the response.
When a pericardial effusion becomes symptomatic without evidence of inflammation, or when empiric therapy with anti-Inflammatory drugs is not successful, drainage of the effusion should be considered either by percutaneous or surgical means.
Cardiac tamponade is a life-threatening hemodynamic condition resulting from pericardial effusions that increase intra pericardial pressure sufficiently to externally compress and restrict cardiac chamber filling, constrain cardiac output and induce backward failure.
Acute cardiac tamponade with hemodynamic compromise requires urgent evacuation of pericardial fluid, either by percutaneous means (with a needle or balloon catheter) or surgical means (via subxiphoid incision, video-assisted thoracoscopy, or thoracotomy).
Pericardial constriction occurs when the fibrotic pericardium impedes normal diastolic filling because of loss of elasticity. Usually the pericardium is considerably thickened, but it can be of normal thickness in up to 20 % of cases.
The standard therapy in patients with chronic constrictive pericarditis who have persistent and prominent symptoms, is an extended pericardiectomy, performed to restore an unlimited inflow and outflow as well as an unrestricted diastolic function of both ventricles.