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Advances in Experimental Medicine and... 2024Congenital anomalies and acquired diseases of the coronary blood vessels are of great clinical relevance. The early diagnosis of these conditions remains, however,... (Review)
Review
Congenital anomalies and acquired diseases of the coronary blood vessels are of great clinical relevance. The early diagnosis of these conditions remains, however, challenging. In order to improve our knowledge of these ailments, progress has to be achieved in the research of the molecular and cellular mechanisms that control development of the coronary vascular bed. The aim of this chapter is to provide a succint account of the key elements of coronary blood vessel development, especially in the context of the role played by the epicardium and epicardial cellular derivatives. We will discuss the importance of the epicardium in coronary blood vessel morphogenesis, from the contribution of the epicardially derived mesenchyme to these blood vessels to its role as an instructive signaling center, attempting to relate these concepts to the origin of coronary disease.
Topics: Pericardium; Humans; Coronary Vessels; Animals; Signal Transduction; Mesoderm; Morphogenesis
PubMed: 38884710
DOI: 10.1007/978-3-031-44087-8_8 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2021
Topics: Adipose Tissue; Humans; Pericardium
PubMed: 34523589
DOI: 10.5543/tkda.2021.21189 -
Cardiac Electrophysiology Clinics Sep 2020Supraventricular arrhythmias are the most common cardiac arrhythmias encountered; however, it is uncommon that supraventricular tachycardias require percutaneous... (Review)
Review
Supraventricular arrhythmias are the most common cardiac arrhythmias encountered; however, it is uncommon that supraventricular tachycardias require percutaneous epicardial access for successful mapping and ablation. There are particular scenarios where epicardial access and ablation should be considered. Certain accessory pathways particularly in the posteroseptal region may require epicardial access for successful ablation. These pathways may also be approached from within the coronary sinus system. In addition, tachycardias near the phrenic nerve in the right atrium or left atrium may require epicardial access for successful ablation or to allow displacement of the phrenic nerve facilitating safe catheter ablation.
Topics: Catheter Ablation; Epicardial Mapping; Humans; Pericardium; Tachycardia, Supraventricular
PubMed: 32771189
DOI: 10.1016/j.ccep.2020.05.001 -
Cardiac Electrophysiology Clinics Sep 2020Hybrid surgical ventricular tachycardia (VT) ablation combines surgical epicardial access/exposure with contemporary mapping and ablation techniques adapted from... (Review)
Review
Hybrid surgical ventricular tachycardia (VT) ablation combines surgical epicardial access/exposure with contemporary mapping and ablation techniques adapted from percutaneous catheter ablation procedures. Patients considered for a hybrid surgical approach for VT are those who have had prior cardiac surgery or failed percutaneous epicardial access due to pericardial adhesions. They often represent the most challenging end of the spectrum of patients and usually have undergone multiple unsuccessful ablations. In this review, the indications, preprocedure work-up, ablation techniques, and outcomes from hybrid surgical access VT ablations are discussed as well as key technical details that present unique challenges to its success.
Topics: Arrhythmias, Cardiac; Catheter Ablation; Epicardial Mapping; Humans; Pericardium
PubMed: 32771191
DOI: 10.1016/j.ccep.2020.05.002 -
Current Cardiology Reports Oct 2021Pericardial diseases include a wide range of pathologies and their diagnosis can often be challenging. The goal of this review is to describe the established and... (Review)
Review
PURPOSE OF REVIEW
Pericardial diseases include a wide range of pathologies and their diagnosis can often be challenging. The goal of this review is to describe the established and emerging CMR imaging techniques used in the assessment of common pericardial diseases and explain the role of pericardial characterization in their diagnosis and management.
RECENT FINDINGS
CMR is indicated in cases of diagnostic uncertainty and for a comprehensive evaluation of the pericardium and its impact on the heart. This includes assessment of pericardial anatomy and associated cardiac hemodynamics, quantification and characterization of an effusion, disease staging, tissue characterization, guiding management, and even prognostication in some diseases of the pericardium. An emerging technique, pericardial characterization, utilizes various sequences to diagnose and stage pericardial inflammation, act as a biomarker in recurrent pericarditis, and guide management in inflammatory pericardial conditions. Beyond imaging, it has ushered in an era of tailored therapy for patients with pericardial diseases. Future directions should aim at exploring the role of tissue characterization in various pericardial diseases.
Topics: Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Pericarditis; Pericardium; Tomography, X-Ray Computed
PubMed: 34622359
DOI: 10.1007/s11886-021-01595-z -
Cardiovascular Pathology : the Official... 2021The pericardium is a double-layered fibro-serous sac that envelops the majority of the surface of the heart as well as the great vessels. Pericardial fluid is also... (Review)
Review
The pericardium is a double-layered fibro-serous sac that envelops the majority of the surface of the heart as well as the great vessels. Pericardial fluid is also contained within the pericardial space. Together, the pericardium and pericardial fluid contribute to a homeostatic environment that facilitates normal cardiac function. Different diseases and procedural interventions may disrupt this homeostatic space causing an imbalance in the composition of immune mediators or by mechanical stress. Inflammatory cells, cytokines, and chemokines are present in the pericardial space. How these specific mediators contribute to different diseases is the subject of debate and research. With the advent of highly specialized assays that can identify and quantify various mediators we can potentially establish specific and sensitive biomarkers that can be used to differentiate pathologies, and aid clinicians in improving clinical outcomes for patients.
Topics: Humans; Pericardial Fluid; Pericardium
PubMed: 34023529
DOI: 10.1016/j.carpath.2021.107346 -
Circulation. Cardiovascular Imaging Jul 2022Cardiac magnetic resonance imaging plays a central role among multimodality imaging modalities in the assessment, diagnosis, and surveillance of pericardial diseases.... (Review)
Review
Cardiac magnetic resonance imaging plays a central role among multimodality imaging modalities in the assessment, diagnosis, and surveillance of pericardial diseases. Clinicians and imagers should have a foundational understanding of the utilities, advantages, and limitations of cardiac magnetic resonance imaging and how they integrate with other diagnostic tools involved in the evaluation and management of pericardial diseases. This review aims to outline the contemporary magnetic resonance imaging sequences used to evaluate the pericardium, followed by exploring the main clinical applications of magnetic resonance imaging for identifying pericardial inflammation, constriction, and effusion.
Topics: Heart Diseases; Humans; Magnetic Resonance Imaging; Multimodal Imaging; Pericardial Effusion; Pericarditis, Constrictive; Pericardium
PubMed: 35861978
DOI: 10.1161/CIRCIMAGING.122.014283 -
Anatomia, Histologia, Embryologia May 2021The use of biological membranes in surgeries is a reality for years, and one of the most used is the bovine pericardium, so the purpose of this research is to describe...
The use of biological membranes in surgeries is a reality for years, and one of the most used is the bovine pericardium, so the purpose of this research is to describe the bovine pericardium's biomechanics by comparing two directions of a test, one parallel to the longitudinal heart axis and one perpendicular. 20 adult bovine pericardium were tested for the maximum rupture force and rupture elongation, collecting four samples of each pericardium direction. In phase 2, eight pericardia were conserved for 4 months in a 98% glycerine solution, and the solution in which they were submerged was microbiologically analysed monthly. The Mann-Whitney test was used; there was a very significant difference between the perpendicular and parallel groups (p = .0001). The T test showed no significant difference for the rupture elongation (p = .0938). In pericardium preserved in glycerine, the outliers were removed regarding the maximum rupture force, and a Boxcox transformation was performed (λ = 0.25). Outliers were removed for the rupture elongation, and Bartlett's test (p = .7836), and Cramer-Von Mises (p = .5033) were performed and then, the analysis of variance (p < .0001), followed by the Tukey test at 5%. In the microbiological analysis, there was no presence of microorganisms during conservation. The research has shown that the pericardium collection direction influences its resistance and it can be stored in glycerine for 4 months without losing biomechanical characteristics.
Topics: Animals; Biomechanical Phenomena; Cattle; Pericardium
PubMed: 33620085
DOI: 10.1111/ahe.12665 -
Cardiac Electrophysiology Clinics Sep 2020The observations afforded by epicardial mapping have not only increased the appreciation of distinct epicardial structures in the left atrium but also underscore the... (Review)
Review
The observations afforded by epicardial mapping have not only increased the appreciation of distinct epicardial structures in the left atrium but also underscore the need to address the substrate transmurally. Although epicardial access and ablation have attendant risks, comparative studies with hybrid surgical approaches are lacking. In the search to find unifying mechanisms of atrial fibrillation, a conceptual shift that emphasizes the substrate in 3 dimensions, with the epicardium distinct from the endocardium, holds promise for future investigation and evolving therapeutic tools.
Topics: Atrial Fibrillation; Catheter Ablation; Epicardial Mapping; Humans; Pericardium
PubMed: 32771190
DOI: 10.1016/j.ccep.2020.06.005 -
Cardiac Electrophysiology Clinics Sep 2020Ventricular arrhythmias (VAs) occurring in the absence of structural heart disease or ion channelopathies are referred to as idiopathic. They can clinically present with... (Review)
Review
Ventricular arrhythmias (VAs) occurring in the absence of structural heart disease or ion channelopathies are referred to as idiopathic. They can clinically present with frequent monomorphic premature ventricular contractions, nonsustained ventricular tachycardia (VT), or sustained VT, and generally share a benign prognosis. Approximately 4% to 10% of idiopathic VAs have an epicardial site of origin, represented in most cases by the left ventricular summit and, less frequently, by the cardiac crux. Epicardial foci can be addressed by catheter ablation via the coronary venous system tributaries. In rarer instances, a direct epicardial access from a subxiphoid approach is needed.
Topics: Catheter Ablation; Epicardial Mapping; Humans; Pericardium; Tachycardia, Ventricular
PubMed: 32771184
DOI: 10.1016/j.ccep.2020.04.005