Anatomy of the heart the pericardium

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Rim Halaby, Yazan Daaboul

Overview

The pericardium is a double-walled sac containing the heart and the roots of the great vessels.

The Pericardium

  • The pericardium is a sac that embeds the heart. It is pierced by the great vessels. Morphologically, it is a conical-shaped, double-walled fibro-serous membrane.
  • The pericardial sac rests posteriorly to the sternum at the level of second to sixth costal cartilages and T5-T8 vertebrae.
  • The pericardium is made of two layers:
    • Fibrous pericardium
      • Hard protective external layer
      • Attached to sternum anteriorly by sterno-pericardial ligaments and fused with the central tendon of the diaphragm and great vessels to allow mobility of the pericardial sac against sudden cardiac overfilling.
    • Serous Pericardium
      • Smooth internal layer made of 2 components:
        • Parietal: reflects onto fibrous pericardium
        • Visceral: reflects onto heart and great vessels and forms the epicardium, the external layer of the heart wall.
  • Pericardial cavity: Potential space between parietal and visceral layers. It contains a serous fluid film that occupies the cavity and functions as lubricant against friction by all chest movements.

Pericardial Sinuses

  • Pericardial sinuses are channels or chambers between the visceral and parietal pericardia.
  • Transverse sinus:
    • Located posterior to the pulmonary trunk and ascending aorta at the level between the superior vena cava and aortic arch.
    • Formed after dorsal mesocardium rupture embryonically
    • Functional role is to allow the unhindered expansion of great arteries posteriorly during cardiac systole.
    • Utilized surgically to pass surgical clamps or place ligatures around great arteries.
  • Oblique sinus:
    • A blind recess (cul-de-sac) posterior to the left atrium between superior vena cava, right and left pulmonary veins inferior to the transverse sinus.
    • Formed embryonically by the incorporation of the pulmonary vein tributaries into the left atrium.
    • Functional role believed to be the expansion of the left atrium upon normal collapse of the thorax.[1][2][3]
Below are images showing the pericardium and pericardial sinuses.

References

  1. Kishore, K. (2003). The Heart of Structural Development: The Functional Basis of the Location and Morphology of the Human Vascular Pump. J Postgrad Med, 49:282-4.
  2. Moore, K. L., Agur, A. M., & Dalley, A. F. (2011). Essential Clinical Anatomy - Fourth Edition. Lippincott Williams & Wilkins.
  3. Tank, P. W. (2009). Grant's Dissector - Fourteenth Edition. Lippincott Williams & Wilkins.


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