Pericardium

INTRODUCTIO
N
• Pericardium
– conical fibroserous sac
– encloses the heart and roots of the great vessels

• Lies within middle mediastinum.

• Lies behind body of sternum and second to sixth costal cartilages.
Functions of Pericardium
1. Protection of heart (shock absorption).
2. Restriction of excessive movements of heart
3. Prevention of overexpansion of heart
4. Prevents kinking of great blood vessels
5. Minimizes friction between heart and surrounding structures
6. Mechanical barrier for the spread of infection
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Subdivisions of pericardium
1. Fibrous pericardium
• Outer layer of pericardium
• Single-layered, thick, and cone-shaped sac that encloses heart and
fuses with roots of the major vessels.
2. Serous pericardium
• Inner double-layered blind sac of the pericardium
• Two layers:
a.Parietal layer: Lines inner surface of fibrous pericardium
b.Visceral layer or epicardium: Lines outer surface of heart and great blood
vessels 3
Human Anatomy/Yogesh Sontakke 4
FIBROUS PERICARDIUM
Q. Write a short note on fibrous pericardium.
• Cone-shaped
• Thick sac of fibrous connective tissue.
Features of Fibrous Pericardium
1. Conical and has apex and base.
2. Apex – directed above and blends with
external coats of ascending aorta and
pulmonary trunk.
3. Base – broad and fuses with central tendon of
diaphragm

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FIBROUS PERICARDIUM
Features of Fibrous Pericardium
4. Anteriorly – Connected with sternum by
superior and inferior sternopericardial
ligaments.
5. Posteriorly – related to principal bronchi,
esophagus, and descending thoracic aorta.
6. On each side – related to mediastinal pleura,
phrenic nerves, and pericardiophrenic vessels.
7. Protects and keeps heart in place.
8. Prevents over distension of heart and kinking
of great vessels Viva
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SEROUS PERICARDIUM
• Thin, double-layered serous sac that lies within fibrous pericardium.
• Lined by a simple squamous epithelium called mesothelium.

Layers of Serous Pericardium

• Consists of two layers
1. Parietal layer: Outer layer and lines the inner surface of the fibrous
pericardium.
2. Visceral layer (epicardium): Inner layer, covers external surface of heart and
root of the great vessels.
Visceral layer is continuous with the parietal layer along the roots of great blood
vessels.
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PERICARDIAL CAVITY
•Potential space between parietal and visceral layers of serous
pericardium.
• Normally, it contains a small amount of serous fluid (15–20 mL) –
pericardial fluid.
• Pericardial fluid reduces friction.

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 CONTENTS OF PERICARDIUM
1. Heart
2. Ascending aorta
3. Pulmonary trunk
4. Lower half of superior vena cava
5. Terminal part of inferior vena cava
6. Terminal part of pulmonary veins

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 BLOOD SUPPLY AND NERVE SUPPLY
Blood Supply

Fibrous and parietal layer of visceral pericardium

• Arterial supply: Branches of internal thoracic, musculophrenic arteries, and

descending thoracic aorta.

• Venous drainage: Azygos and internal thoracic veins.

Visceral pericardium

• Arterial supply: Coronary arteries

• Venous drainage: Coronary sinus. 10

 BLOOD SUPPLY AND NERVE SUPPLY
Nerve Supply

• As fibrous and parietal pericardium develop from somatopleuric mesoderm. They are
supplied by phrenic (somatic) nerves and they are pain sensitive.Viva

• As visceral pericardium develops from splanchnopleuric mesoderm. It is supplied by

branches of sympathetic trunk and vagus nerve (autonomic nerves) and it is insensitive
to pain.Viva

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SINUSES OF PERICARDIUM
Q. Write a short note on sinuses of
pericardium.
• Communicating zones that are
developed by the reflection of serous
pericardium.
• Two sinuses of pericardium
1. Transverse sinus
2. Oblique sinus

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 SINUSES OF PERICARDIUM
Reason behind sinuses of pericardium
• Visceral pericardium forms two tubes around the
great vessels of heart as follows:
– One arterial tube around embryonic arterial end
of the heart that later forms ascending aorta and
pulmonary trunk.
– Another venous tube around the embryonic
venous end of heart that later forms superior and
inferior venae cavae and forms pulmonary veins.
• Initially, arterial and venous ends are connected
by dorsal mesocardium which later disappears and
forms transverse sinus.
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Fig. 11.7:
Transverse section of heart passing through the
atria, root of ascending aorta, and pulmonary
trunk.
Transverse sinus lies between pulmonary trunk,
aorta anteriorly, and left atrium behind

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 Transverse Sinus
Q. Write a short note on transverse sinus of
pericardium.
• Horizontal passage between anterior arterial end and
posterior venous end of the heart. Viva, Next
• Develops on degeneration of dorsal mesocardiumNext
Boundaries
Anterior: Ascending aorta, pulmonary trunkNext
Posterior: Superior vena cavaNext
Inferior: Left atrium
Superior: Bifurcation of pulmonary trunkNext
On each side: Opens into the main pericardial cavity.

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 Oblique Sinus
Q. Write a short note on oblique sinus of pericardium.
• Cul-de-sac behind the left atrium.
• Recess of serous pericardium enclosed by a J-shaped
sheath of visceral pericardium – that encloses six veins:
superior and inferior venae cavae and four pulmonary
veins.
Development
Oblique sinus develops due to absorption of 4
pulmonary vein into the developing left atrium.
Importance
It allows distension of left atrium during return of
oxygenated blood from the lungs. 17
 Oblique Sinus
Boundaries
Anterior: Left atrium
Posterior: Parietal pericardium
On the right: Two right pulmonary veins and
inferior vena cava
On the left: Two left pulmonary veins
Superior: Reflection of visceral pericardium along
the right and left superior pulmonary veins (along
the upper margin of left atrium)
Inferior: Communicates with the main pericardial
cavity.
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 Clinical Integration
• Significance of transverse pericardial sinus: During
cardiac surgery, temporary ligature may be passed
through transverse sinus to block the blood flow
through aorta and pulmonary trunk.

• Pericarditis: Inflammation of the pericardium

• Pericardial friction rub: In pericarditis, smooth

opposing surfaces of serous pericardium become
rough. It results in pericardial friction rub. Can be
heard as the rustle of silk with the use of stethoscope. 20
Human Anatomy/Yogesh Sontakke 21
Clinical Integration
• Pericardial effusion
– Accumulation of excessive fluid in the
pericardial cavity.
– Causes: Congestive heart failure,
pericarditis, tuberculosis, kidney failure,
heart surgery, and so on.
– Pressure on heart and prevention of
complete filling of chamber of the heart.
–water-bottle heart on chest radiographNeet

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• Cardiac tamponade: Compression of the
heart – Due to inelastic nature of tough
fibrous pericardium.
Reduces filling of cardiac chambers during
diastole and thus reduces cardiac output.

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Clinical Integration
Pentalogy of Cantrell (thoracoabdominal syndrome):
Rare congenital anomaly that has the following defects:Neet
1. Omphalocele (protruding abdominal viscera through umbilicus)
2. Anterior diaphragmatic hernia
3. Sternal defect
4. Ectopia cordis due to absence of pericardiumNeet
5. Heart malformation

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Box 11.1: Pericardiocentesis • Aspiration of fluid from pericardiumViva
• Position of patient: Supine, head end of the
bed raised by 30°–60° to bring the heart
closer to the anterior chest wall.
• Procedure: It can be done using two
approaches:
1. Subxiphoid approach: The needle is
inserted in left costoxiphoid angle with an
upward inclination of about 45° to skin.Next
2. Parasternal route: A needle is introduced
into left 5th or 6th intercostal space at left
sternal border under ultrasound guidance.
This is preferred elective procedure. Next

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Thank you………….

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