Perikardiektomia torakoskopowa. Wskazania i techniki u małych zwierząt. Część II/Thoracoscopic pericardectomy. Indications and techniques in small animals. Part II

What happens after pericardectomy?

The pericardium protects the heart from adjacent infection and malignancy and prevents its dislocation by fixing it within the thorax. Pericardium also restrains cardiac filling and enhances diastolic coupling of the ventricles.

The pericardium comprises two distinct layers: the parietal pericardium, which is the tough outer fibroserous membrane, and the visceral pericardium (also termed epicardium), which is the more delicate inner serous membrane firmly connected to the heart. Pericardial cavity is interposed between these two layers. It is continuous with the adventitia of the great vessels at the heart base and with the sternopericardial ligament, which attaches the apex of the pericardium to the ventral aspect of the muscular diaphragm. In this fashion, the heart is anchored within the thorax. This anchorage is lost after pericardectomy.

The parietal pericardium derives its blood supply from branches of the internal thoracic artery, the aorta, and superficial branches of the coronary arteries. Lymphatic drainage of the pericardial sac occurs mainly by vessels that empty into the pretracheal and cardiac lymph nodes and to a lesser extent by lymphatic vessels returning to the sternal lymph nodes.

The risk of secondary infection after pericardectomy has not been evaluated and the loss of ventral attachment has not been studied. Whenever the remaining pericardium is still producing some fluid, the latter will be reabsorbed by the pleura.

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