1. Contrast Pericardiography Facilitates Intrapericardial Navigation Under Fluoroscopy 
William E. Cohn, MD, Jo Anna Winkler, BS, Egemen Tuzun, MD, Aaron Hjelle, Kevin Bassett, MBA, Abdolhaliem Ahmad, MD, O.H. Frazier, MD 
The Annals of Thoracic Surgery 
Volume 90, Issue 5, Pages (November 2010)
DOI: /j.athoracsur
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Fluoroscopic image of the mediastinum without pericardial contrast showing the cardiac silhouette with no definition of individual cardiac structures. The image is a fairly homogeneous grey shadow, not unlike the human cardiac silhouette on a standard chest X-ray.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Fluoroscopic image after injection of 20 cc of ionic contrast into the pericardial space showing multiple vertical and oblique lines, representing accumulation of contrast, that delineate various cardiac structures. See Figure 3 for additional description.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
The right atrial appendage (A), left atrial appendage (B), main pulmonary artery (C), inferior vena cava (D), medial coronary sinus (E), superior vena cava (F), and ascending aorta (G) are readily identified after contrast pericardiography due to opacification of fissures separating them from surrounding structures. The short horizontal line that extends 3 to 4 cm to the left from the left border of the inferior vena cava, where it joins the right atrium, is the ventricular margin of the medial coronary sinus. If the cardiac restraint device is not advanced to that shadow, it will not be in the correct position. Similarly, the device will not sit in the atrioventricular groove if it is placed toward the apex of the ventricular margins of the right and left atrial appendages. If the device is advanced beyond these lines, the right atrial appendage and left atrial appendage will be caught within the cardiac restraint device.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions