Pericardium

The pericardium (the pericardium; from the Greek. perikardios - okoloserdecna; synonym: okoloserdecna bag, heart chemise) is a closed saccular education surrounding the heart and consisting of two pieces: the parietal (the pericardium) and visceral (epicardial).
Anatomy and histology. The epicardium (epicardium) directly covers the heart muscle and spliced with it. It has the structure of the serous membranes consisting of mesothelial, border membrane, wavy surface of the collagen layer elastic network and deep collagen-elastic layer (Fig. 1).
Actually the pericardium consists of two layers: the inner serous (pericardium serosum) and outer fibrous (pericardium fibrosum). Fibrous layer pericardium are surface, medium and deep wavy collagen-elastic beams.

the structure of the epicardium
Fig. 1. The scheme of the structure of the epicardium: 1 - mesotheli; 2 - border membrane; 3 - wavy surface collagen layer; 4 - elastic net; 5 - deep collagen-elastic layer.



Fig. 2. Differences in topographo-anatomical relations of the transition folds pericardium on vessels root of the heart (the numbers mark the parties covering the pericardium vessels): 1 - the aorta; 2 - pulmonary trunk; 3 - left pulmonary vein; 4 - bottom left pulmonary vein; 5 - the lower hollow vein; 6 - the right lower lung Vienna; 7 - right top pulmonary vein; 8 - superior Vena cava.

Visceral sheet pericardium (the epicardium), passing into the outer forms a transitional line, which runs on a different level from the place of entry and exit from the heart of large vessels (Fig. 2). Between epicardial and actually P. has a narrow cavity (cavum pericardii) with negative pressure in it containing the normal 15 - 30 ml clear pale yellow liquid.
The pericardium is surrounded by a loose connective tissue. At the top he goes into adventitia large vessels of the heart, in front attached sternum-pericardial ligaments (ligg. sternopericardiaca) to the inner surface of the sternum, below is fixed to the diaphragm, the sides spliced with mediastinal pleura (Fig. 3 and 4), and back - spine-pericardial ligaments with predposlednii fascia.


Fig. 3. The position of the heart in the pericardium cavity (front): 1 - n. vagus sin.; 2 - pulmo sin.; 3 - a. pulmonalis; 4 - ventriculus sin.; 5 - apex cordis; 6 - diaphragma; 7 - ventriculus dext.; S - pericardium; 9 - aorta ascendens; 10 - v. cava sup.; 11 - arcus aortae.






the pericardium
Fig. 4. The pericardium (okoloserdecna bag) - rear wall (front): 1 - arcus aortae; 3 - ramus dext. a. pulmonalis (mouth); 3 - ramus sin. a. pulmonalis (mouth); 4 - ramus sin. a. pulmonalis; 5 - bronchus sin.; 6 - plica v. cavae sin.; 7 - vv. pulmonales sin.; 8 - diaphragma; 9 - section v. cava covered by the pericardium; 10 - v. cava inf.; 11 - vv. pulmonales dext.; 12 - bronchus dext.; 13 - v. cava sup.; 14 - a place of transition of the pericardium on vessels; 15 - sinus obliquus pericardii; 16 - the rear wall of the pericardium.

Ii. has the form of cut wrong cone, located from the top of the third rib to xiphoid process, giving the right over the edge of a breast bone on 1 - 2 cm, left - on 7-8 see
From a surgical point of view, the pericardium can be divided into the following parts. Diaphragmatic part of the Isthmus, on the plane where the heart moves when systole and diastole, intimately joined with the diaphragm. Between the front edge of the heart and the edge of the diaphragmatic part of Peterhof is free space - front bottom sinus P. (in this place to make a puncture P. side xiphoid process).
Sternocostal part P. covered the front edges of the pleural bags that leave between themselves free mezhplevralny period (see Pleura).
Dimensions mezhplevralny span different in norm and pathology. With significant effusion in Petrograd this gap is widening. The most constant-free pleura plot P. IV-V-th intercostal space to the left of the sternum ("safety triangle" - A. R. Voynich-Syanozhentskiy, 1897). Knowledge of the location of the internal thoracic artery (0.5-1 cm outwards from the edge of the sternum) allows to avoid damage to them with a puncture P.
A large part of Peterhof is its several parts, covered tightly joined with them mediastinal pleura. Here are phrenic nerves with accompanying vessels. Rear P. facing the spine and separated from it by the esophagus, the descending aorta, thoracic lymphatic duct and unpaired Vienna.
Between the aorta and pulmonary artery covered by the General sheets epicardium, and located posterior to them superior Vena cava and the wall atrium is formed narrow space of the transverse sinus pericardium (sinus transversus pericardii). Its practical significance is revealed from the operations in the pulmonary arteries (A. N. Bakulev, 1961). In connection with the peculiarities of embryonic development in places of transition sheets P. formed a few blind pockets. The most significant - slash sinus P. (sinus obliquus pericardii).
Parietal sheet pericardium receives blood through the branches of the internal thoracic, diaphragmatic, bronchial and esophageal arteries. The epicardium a blood supply due to peripheral coronary arteries. The outflow of blood is on the veins of the same name. Lymphatic capillaries and vessels epicardial associated with the lymphatic system of the heart. Discharge lymphatic vessels P. sent to the regional lymph nodes in the mediastinum. This explains the transition and distribution of inflammatory process. Lymphatic and blood vessels serous sheets P. participate in the process of exchange of pericardial fluid (see Mesotheli).
Innerviruetsya P. branches cervical sympathetic nodes, wandering and phrenic nerves and heart, lung and esophageal entanglements. When pericarditis observed functional disorders of the activity of the esophagus, diaphragm, as well as pseudorandomly syndrome (see).
The pericardium is a rich receptor area, irritation which causes changes hemodynamic indices and breathing.