The pericardium is a double-walled fibroserous membrane that surrounds the heart. It has a fibrous outer layer and a serous inner layer known as the epicardium. The pericardium maintains the heart's position, acts as a barrier to infection, and lubricates the space between the layers. It contains pericardial sinuses and has attachments superiorly, inferiorly, and posteriorly in the mediastinum. The pericardium receives its blood supply from branches of the phrenic and intercostal arteries and drains into veins that empty into the azygos system. It is innervated by the phrenic nerve and vagus nerve. Card

1. PERICARDIUM
ANATOMYShahd AlAli

2.  Located in the middle mediastinum
 It’s a double walled fibroserous membrane
 Fibrous pericardium “embryological origin”,
collagen and elastic fibers
 Serous pericardium “mesothelium”
 partial
 visceral “epicardium”
 Pericardial fluid volume & pressure
The functions of the
pericardium:
• Maintains the position
of the heart
• Barrier to infections
• Lubrication between
visceral and partial
layers

3. Pericardial Sinuses
Transverse sinuous Oblique sinuous

4. Development of the Pericardial Sinuous

5. • The oblique sinuses
separates the
esophagus from the
left atrium

6. Surgical Significance of Transverse
Pericardial Sinuous
coronary artery bypass grafting
surgical clumps

7. Relations of the Pericardium
• Anterior
• Inferior
• Lateral

8. Posterior Relations DATE
T5-T8

9. Attachments
 Superiorly tunica adventitia (perivascular
connective tissue)
 Inferiorly to the diaphragm
 Sternum attachment
 Posterior by loose connective tissue
Affected by their movement

10. Arterial Supply
 Mainly from the pericardiophrenic artery
Smaller contribution from the
 Musclophrenic artery
 Bronchial artery
 Esophageal
 Superior phrenic artery
 Coronary artery supplies the visceral layer ONLY

11. Venous drainage
 Pericardiophrenic veins
 Azygos venous system

12. Innervations
 Phrenic nerve (C3-
C5) sensory fibers
Partial & Fibrous
“Sensitive to pain”
 Vagus nerve &
Sympathetic
(vasomotor)

14. Cardiac Tamponade

15. Clinical ~
 Pericardiocentesis:
 Parasternal
left 5th or 6th intercostal spaces.
 Subxiphoidal approach
Thoracocentesis ???