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Living Anatomy of the Pericardial Space: A Guide for Imaging and Interventions

Lookup NU author(s): Professor Bob Anderson


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© 2021 American College of Cardiology FoundationThe pericardium of the human heart has received increased attention in recent times due to interest in the epicardial approach for cardiac interventions to treat cardiac arrhythmias refractory to conventional endocardial approaches. To support further clinical application of this technique, it is fundamental to appreciate the living anatomy of the pericardial space, as well as its relationships to the surrounding structures. The anatomy of the pericardial space, however, is extremely difficult regions to visualize. This is due to its complex 3-dimensionality, and the “potential” nature of the space, which becomes obvious only when there is collection of pericardial fluid. This potential space, which is bounded by the epicardium and pericardium, can now be visualized by special techniques as we now report, permitting appreciation of its living morphology. Current sources of knowledge are limited to the dissection images, surgical images, and/or illustrations, which are not necessarily precise or sufficient to provide relevant comprehensive anatomical knowledge to those undertaking the epicardial approach. The authors demonstrate, for the first time to their knowledge, the 3-dimensional living anatomy of the pericardial space relative to its surrounding structures. They also provide correlative anatomy of the left sternocostal triangle as a common site for subxiphoid access. The authors anticipate their report serving as a tool for education of imaging and interventional specialists.

Publication metadata

Author(s): Mori S, Bradfield JS, Peacock WJ, Anderson RH, Shivkumar K

Publication type: Review

Publication status: Published

Journal: JACC: Clinical Electrophysiology

Year: 2021

Volume: 7

Issue: 12

Pages: 1628-1644

Print publication date: 01/12/2021

Online publication date: 24/11/2021

Acceptance date: 21/09/2021

ISSN (print): 2405-500X

ISSN (electronic): 2405-5018

Publisher: Elsevier Inc.


DOI: 10.1016/j.jacep.2021.09.008