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Heart Failure Clinics Jan 2021Disorders of the pericardium are common and can result in significant morbidity and mortality. Advances in multimodality imaging have enhanced our ability to diagnose... (Review)
Review
Disorders of the pericardium are common and can result in significant morbidity and mortality. Advances in multimodality imaging have enhanced our ability to diagnose and stage pericardial disease and improve our understanding of the pathophysiology of the disease. Cardiovascular MRI (CMR) can be used to define pericardial anatomy, identify the presence and extent of active pericardial inflammation, and assess the hemodynamic consequences of pericardial disease. In this way, CMR can guide the judicial use of antiinflammatory and immune modulatory medications and help with timing of pericardiectomy. CMR can also be used to diagnose congenital disorders of the pericardium. Furthermore, CMR can be used to define pericardial masses and understand their malignant potential.
Topics: Humans; Magnetic Resonance Imaging, Cine; Pericardial Effusion; Pericarditis, Constrictive; Pericardium
PubMed: 33220880
DOI: 10.1016/j.hfc.2020.08.008 -
Cardiac Electrophysiology Clinics Sep 2020The pericardial cavity and its boundaries are formed by the reflections of the visceral and parietal pericardial layers. This space is an integral access point for... (Review)
Review
The pericardial cavity and its boundaries are formed by the reflections of the visceral and parietal pericardial layers. This space is an integral access point for epicardial interventions. As the pericardial layers reflect over the great vessels and the heart, they form sinuses and recesses, which restrict catheter movement. The epicardial vasculature is also important when performing nearby catheter ablation. The phrenic nerve and esophagus are other important structures to appreciate so as to avoid collateral injury. In addition, the Larrey space, or left sternocostal triangle, is a key avascular window through which pericardial access can be safely achieved.
Topics: Catheter Ablation; Coronary Vessels; Electrophysiologic Techniques, Cardiac; Esophagus; Humans; Pericardium; Phrenic Nerve
PubMed: 32771181
DOI: 10.1016/j.ccep.2020.04.003 -
Cardiac Electrophysiology Clinics Jun 2021Catheter-based ultrasonography is a widely used tool in cardiac electrophysiology practice, and intracardiac echocardiography is supplanting other forms of imaging to... (Review)
Review
Catheter-based ultrasonography is a widely used tool in cardiac electrophysiology practice, and intracardiac echocardiography is supplanting other forms of imaging to become the dominant imaging modality. Given advances in pericardial access, intrapericardial echocardiography can be performed using ultrasound catheters as well. Intrapericardial echocardiography and echocardiography from the coronary sinus, also an epicardial structure, allows interventionalists to obtain unique views from virtually any vantage point, compared with other forms of echocardiography. Both intrapericardial echocardiography and coronary sinus echocardiography are safe and important alternatives that can be used during complex procedures in the electrophysiology laboratory.
Topics: Catheter Ablation; Coronary Sinus; Echocardiography; Electrophysiologic Techniques, Cardiac; Humans; Pericardium
PubMed: 33990277
DOI: 10.1016/j.ccep.2021.03.003 -
Cardiac Electrophysiology Clinics Sep 2020The pericardial space provides a unique vantage point to access different cardiac structures for diagnosis and treatment of arrhythmias and other nonelectrophysiologic... (Review)
Review
The pericardial space provides a unique vantage point to access different cardiac structures for diagnosis and treatment of arrhythmias and other nonelectrophysiologic conditions, such as heart failure. There have been notable innovations to improve safety of percutaneous pericardial access and its use for various procedures. Percutaneous pericardial device therapies for pacing and defibrillation have been in development, success of which will be a significant advance in treatment of bradyarrhythmias, cardiac resynchronization therapy, and prevention of arrhythmic deaths. There is need for continued efforts in development and expansion of this technique and a systematic approach to monitor efficacy and safety outcomes.
Topics: Arrhythmias, Cardiac; Catheter Ablation; Epicardial Mapping; Humans; Pericardium
PubMed: 32771195
DOI: 10.1016/j.ccep.2020.04.007 -
Cardiac Electrophysiology Clinics Sep 2020In patients with nonischemic cardiomyopathy, epicardial ablation is critical in targeting epicardial paravalvular substrate. Epicardial access and ablation can be... (Review)
Review
In patients with nonischemic cardiomyopathy, epicardial ablation is critical in targeting epicardial paravalvular substrate. Epicardial access and ablation can be performed safely with attention to epicardial structures, such as the coronary arteries, phrenic nerve, and epicardial fat. This review explores the indications, techniques, complications, and outcomes of epicardial ablation in patients with nonischemic cardiomyopathy. Although epicardial ablation adds to the complexity and risk of the ablation procedure, it is a vital tool that, combined with endocardial mapping and ablation, improves outcomes in patients with nonischemic cardiomyopathy suffering from ventricular arrhythmias.
Topics: Cardiac Imaging Techniques; Catheter Ablation; Epicardial Mapping; Humans; Pericardium; Tachycardia, Ventricular
PubMed: 32771186
DOI: 10.1016/j.ccep.2020.05.004 -
Multimedia Manual of Cardiothoracic... Dec 2020Chronic constrictive pericarditis results from inflammation and fibrosis of the pericardium. This situation eventually leads to impairment of diastolic filling and right...
Chronic constrictive pericarditis results from inflammation and fibrosis of the pericardium. This situation eventually leads to impairment of diastolic filling and right heart failure. Once the diagnosis is made, because the disease is basically irreversible, a pericardiectomy is the mandatory treatment. The standard surgical treatment has been extensively described. The goal of this video tutorial is to render a visual explanation of the described techniques and to provide tips to help make the procedure easier to perform. The standard technique is performed through a median sternotomy, preferably without cardiopulmonary bypass if feasible. The procedure includes the complete removal of the anterior pericardium from phrenic nerve to phrenic nerve and the removal of the diaphragmatic pericardium and of part of the pericardium posterior to both phrenic nerves. Before starting the actual pericardiectomy procedure, it is useful to separate the pericardial rigid shell from the pleurae and from the diaphragm; this step allows the operator to see both phrenic nerves clearly and to give clear boundaries between the pericardium and the diaphragm, which are not often as clear as desirable due to fat, edema, inflammation, and scarring. Once a portion of the pericardium has been detached from the myocardium, it can be excised, making the portion yet to be removed more visible.
Topics: Adult; Cardiopulmonary Bypass; Heart Failure; Humans; Male; Pericardiectomy; Pericarditis, Constrictive; Pericardium; Sternotomy; Treatment Outcome
PubMed: 33399281
DOI: 10.1510/mmcts.2020.076 -
Journal of Cardiovascular... Jan 2020Since its introduction over two decades ago, percutaneous epicardial procedures have become well-adopted by cardiac electrophysiologists, most commonly for catheter... (Review)
Review
Since its introduction over two decades ago, percutaneous epicardial procedures have become well-adopted by cardiac electrophysiologists, most commonly for catheter ablation of cardiac arrhythmias as well as left atrial appendage closure. The percutaneous epicardial approach has also been utilized for cardiac pacing and drug delivery. But still, its most common usage is for the treatment of intramural and subepicardial substrates that give rise to ventricular tachycardia, particularly in patients with nonischemic cardiomyopathy. In fact, subxiphoid, percutaneous epicardial mapping and ablation have emerged as an important adjunct and in some cases the preferred strategy for characterizing and treating certain types of ventricular arrhythmias. Herein, we will review the indications and rationale for various epicardial procedures. Additionally, we will explore the anatomy of the pericardium as well as the frequently-used epicardial access techniques. We will further examine the optimal approaches and methodologies for epicardial mapping and ablation and the impact of epicardial fat. We will also discuss the epicardial technique for left atrial appendage closure for the purpose of embolic stroke risk reduction. Finally, we will consider the potential for various complications in the setting of epicardial procedures along with their risk factors and discuss strategies to mitigate such adverse events.
Topics: Action Potentials; Arrhythmias, Cardiac; Catheter Ablation; Epicardial Mapping; Heart Rate; Humans; Pericardium; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 31724787
DOI: 10.1111/jce.14282 -
Seminars in Ultrasound, CT, and MR Feb 2024Acute pericardial conditions, such as tamponade, are often rapidly progressive and can become life-threatening without timely diagnosis and intervention. In this review,... (Review)
Review
Acute pericardial conditions, such as tamponade, are often rapidly progressive and can become life-threatening without timely diagnosis and intervention. In this review, we aim to describe bedside ultrasonographic evaluation of the pericardium and diagnostic criteria for tamponade, identify confounders in the diagnosis of pericardial tamponade, and delineate procedural details of ultrasound-guided pericardiocentesis.
Topics: Humans; Pericardial Effusion; Point-of-Care Systems; Pericardium; Cardiac Tamponade; Echocardiography
PubMed: 38056788
DOI: 10.1053/j.sult.2023.12.009 -
Methodist DeBakey Cardiovascular Journal 2023Congenital absence of the pericardium is a rare anomaly, affecting the left pericardium (86%) more than the right, with male predilection distribution (3:1). In the...
Congenital absence of the pericardium is a rare anomaly, affecting the left pericardium (86%) more than the right, with male predilection distribution (3:1). In the majority of cases, the condition is asymptomatic. We describe a case of a 55-year-old female with a history of chronic hypercapnic respiratory failure secondary to restrictive lung disease who was referred to cardiovascular magnetic resonance (CMR) lab for shunt evaluation based on right ventricular pressure overload and paradoxical septal motion.
Topics: Female; Humans; Male; Middle Aged; Pericardium; Magnetic Resonance Imaging
PubMed: 37213871
DOI: 10.14797/mdcvj.1232 -
Expert Review of Cardiovascular Therapy Nov 2019: Acute pericarditis is frequently complicated with recurrences, which represent a diagnostic and therapeutic challenge for the physician, a bothersome trouble for... (Review)
Review
: Acute pericarditis is frequently complicated with recurrences, which represent a diagnostic and therapeutic challenge for the physician, a bothersome trouble for patients. An incorrect treatment of pericarditis may cause further recurrence of symptoms, while an incorrect diagnosis may cause either a prolonged symptoms course with a possible risk of chronic constriction, or useless and potentially harmful treatments.: This review will focus on the most useful and recent diagnostic tools for recurrent pericarditis. Medline/Pubmed Library were screened with specific key search: 'recurrent AND pericarditis'. The research was restricted to papers published in the last 5 years (2015-2019) and papers in English language, in order to appraise the latest advances in diagnostic assessment.: An accurate diagnosis of recurrent pericarditis is critical to provide timely and appropriate treatment of symptoms and prevention of further episodes. Diagnosis is made in case of recurrent symptoms associated with a documented evidence of pericardial inflammation. Further studies are needed to develop newer diagnostic tools aimed at identification of a predominant auto-inflammatory of auto-immune mechanism, which is essential to tailor the treatment.
Topics: Humans; Pericarditis; Pericardium; Recurrence
PubMed: 31709840
DOI: 10.1080/14779072.2019.1691916