1. Pericardium

2. Fibro-serous sac Formed by 2 layers – Outer – fibrous – Inner - serous Enclosing – Heart & parts of Great vessels Aorta, Pulmonary artery SVC & IVC 4 pulmonary veins)

3. Features Shape – conical – Apex upwards – Base downwards Extent – 2 nd to 6 th costal cartilage – Corresponds to T5 – T8 Parts - Fibrous - Serous

4. Fibrous pericardium Conical sac – Truncated apex upwards Enclose heart Prevents over distension of heart

5. Fibrous pericardium - Attachments Apex – Blends with adventitia of great vessels At sternal angle level – Continues with pre-tracheal layer Base – Fuses with upper surface of central tendon

6. Fibrous pericardium - Attachments Anteriorly – – With body of sternum Superior & inferior sterno-pericardial ligaments

7. Fibrous pericardium - Relations Left side – Directly related to Posterior surface of sternum – Pleura deviates towards left Below 4 th costal cartilage (left) – 2 nd 3 rd & 4 th costal cartilage Anterior – Thoracic wall Separated by – Pleura & lung

8. Fibrous pericardium - Relations Posterior – 2 principal bronchi – Thoracic aorta – Esophagus with nerve plexus – Azygos & hemiazygos

9. Fibrous pericardium - Relations Laterally – Phrenic nerve – Pericardiophrenic vessels – Mediastinal pleura

10. Fibrous pericardium - Relations Inferiorly – Diaphragm (central tendon) – Liver (left lobe) – Stomach (fundus)

11. Structures piercing Fibrous pericardium extends along with the vessels which enter or leave the heart – Except IVC Ascending aorta Pulmonary arteries (2) Pulmonary veins (4) Superior vena cava Inferior vena cava

12. Serous pericardium Closed sac – Within fibrous pericardium Consists – Parietal & visceral layers Lined by – Mesothelium

13. Pericardial cavity Space in between the 2 layers of serous pericardium Contains – Pericardial fluid Parietal – Adherent to fibrous Visceral – Adherent to myocardium (known as epicardium)

14. Sinuses Visceral layer continues with parietal layer at the site of Great vessels Forms 2 tubular structures – Arterial Aorta & Pulmonary trunk & – Venous SVC, IVC & PVs 2 spaces – Transverse & Oblique Transverse pericardial sinus Oblique pericardial sinus

15. Transverse sinus Transverse space – Between the 2 serous tubes – Inter visceral space (visceral layer)

16. Transverse sinus-Boundaries – Anterior Ascending aorta & Pulmonary trunk – Posterior Upper margin of left atrium & SVC – Superior Bifurcation of pulmonary trunk – Inferior Superior surface of left atrium – Sides Opens into pericardial cavity

17. Development of transverse pericardium Developing heart elongates and bends – Gradually invaginates into the pericardial cavity Initially – Suspended from the dorsal wall by a mesentery Dorsal mesocardium Central part of this mesentery soon degenerates Arterial and venous ends brought nearer

18. Transverse sinus – applied anatomy During cardiac surgeries – Temporary ligature Pulmonary trunk Aorta

19. Oblique sinus Cul-de-sac – behind left atrium Parieto visceral space Posterior to venous tube

20. Oblique sinus Boundaries – Anteirorly Left atrium – Posteriorly Parietal covering fibrous pericardium – Right Side Right pulmonary veins & IVC – Left side Left pulmonary veins – Superior Upper margin of left atrium – Inferior Space is open

21. Oblique sinus - development Absorption of pulmonary veins – In left atrium Veins expand – Due to growth of left atrium – Pericardium reflect around them Form a space

22. Arterial supply to pericardium Fibrous & parietal layer of serous – Internal thoracic artery – Descending aorta Visceral layer of serous – Coronary arteries

23. Venous drainage of pericardium Fibrous & parietal layer of serous – Into azygos & internal thoracic veins Visceral – Coronary veins

24. Nerve supply to pericardium Fibrous & parietal layer of serous pericardium – Phrenic - sensitive to pain Visceral layer of serous pericardium – Parasympathetic via vagus – Sympathetic via coronary plexus (T1-T5)

25. Applied anatomy to pericardium Pericarditis – Inflammation to pericardium Pericardiocentesis – A long cardiac needle is inserted under the xiphoid approach on the left side of the heart – Using guided imagery (echocardiography) into the chest wall – Until the needle reaches the pericardial sac Pericardial effusion – Abnormal collection of fluid in pericardial cavity