The pericardium is a fibro-serous sac that surrounds the heart and restricts its movement. It has two layers - an outer fibrous layer that maintains the heart's position and an inner serous layer with parietal and visceral layers separated by pericardial fluid. The pericardium protects the heart and provides lubrication as the heart beats within its sac. It has reflections around the major blood vessels leaving the heart and contains openings that allow for blood vessel passage.

1. pericardium
Tashfeen Ahmad

2. What is pericardium?
Greek word meaning around heart
Fibro-serous sac
Lies in the middle mediastinum
Anterior side body of sternum and 2-6 costal
cartilages
Posterior side T5-T8 vertebra
Encloses heart and great vessels
Restricts excessive movement of heart
Provides lubrication

5. In this image with a section thickness of 10 mm, the pericardium
appears as a thin, curvilinear structure (arrows). The pericardium is
typically best visualized along the right side of the heart because of
surrounding fat

6. in horizontal long-axis plane, in which the pericardium appears as a thin,
curvilinear hypointense structure (arrows), best visible when surrounded
by fatty tissue

7. Layers of pericardium
• Two layers of pericardium
• 1)Fibrous pericardium which is the outer layer
and is attached the outer structures maintaining
heart at its position
• 2) serous pericardium which also has two layers
the parietal layer which is along the fibrous
pericardium and the visceral layer which
surrounds the heart hence called the epicardium.
Between both is pericardial cavity which contains
the fluid about 15-20 ml providing lubrication to
heart.

9. Fibrous pericardium
• Fibrous sac and made up 3 cartilagenous layer which protects
overfilling, over expansion of heart and act as physical barrier to
disease
• Conical structure
• Apex: fused with outer layer (adventitia) of great vessels at the level
of sternal angle
• Anteriorly attached to sternum by sterno-pericardial ligament
• Base is braod Inferiorly attached to central ligament of diaphragm
• On its posterior side we have oesophagous , descending Aorta,
bronchi.
• Lateral sides are related to phrenic nerves, pericardiophrenic
vessels , mediastinal pleura and mediastinal surface of lungs.
• Fibrous pericardium covers all great vessels except IVC.

10. • Pain of Injury to pericardium is felt over
supraclavicular surface because the phrenic nerve
arises from C3,C4,C5 and its receptos are present
over supraclavicular region .
• On the anterior side of fibrous pericardium,
sternum is present but lungs and pleural cavity
separates them / present in between them
except at lower left half of body of sternum and
the sternal end of left 4th and 5th costal cartilages
so disection is started from here so that the injury
to pleura and pleural cavity can be prevented.

11. Serous pericardium
• thin, double-layered serous membrane lined by mesothelium
• Subdivided into two.
• 1) Parital layer :fused with fibrous periardium
• reflected around the roots of the great vessels to become continuous with
the visceral layer of serous pericardium that closely covers the heart
• 2)Visceral layer/Epicardium : fused to the heart, except along the cardiac
grooves
• single layer composed of ciliated mesothelial cells on a thin subserosal
layer of connective tissue abundant in elastic fibres,
• The serosal cilia increase the surface area for fluid production and
resorption(degenration)
• Pericardial cavity : space b/w serous layers
• Contains fluid which provides lubrication
• Fluid is 15-20 ml

13. Pericardial reflections
• The reflections of the serosal layer are arranged as two
complex ‘tubes’;
• the aorta and pulmonary trunk are enclosed in one, and
• the venae cavae and four pulmonary veins lie in the other.
• The perivenous tube is an inverted J; the cul-de-sac within
its curve posterior to the left atrium is termed the oblique
sinus.
• The transverse sinus is a passage between the two
pericardial ‘tubes’ ;the aorta and pulmonary trunk are
anterior and the atria and their great veins are posterior

14. Blood supply of pericardium
• The fibrous and parietal pericardia are
supplied by branches from:
• 1 Internal thoracic.
• 2 Musculophrenic arteries.
• 3 The descending thoracic aorta.
• 4 Veins drain into corresponding veins
• The visceral layer is supplied coronary arteries
of heart.

15. Nerve Supply
• The fibrous pericardium and the parietal layer
of the serous pericardium are supplied by the
phrenic nerves.
• The visceral layer of the serous pericardium is
innervated by branches of the sympathetic
trunks and the vagus nerves