Alya Putri Khairani / 130110220220 / B2

Pericardium :

anatomy & histology

ANATOMY
The heart is located within the Pericardial Space which is within the Mediastinum. The apex of the heart is oriented
to the left and lies beneath the costal cartilage of the sixth rib (left). The base of the heart lies under the Sternum
at the level of rib 2.

The heart is housed within the Pericardial Sac or known as Pericardium.

The Pericardium is a conical fibro-serous sac, in which the heart and the roots of the great vessels are contained.
It is placed behind the Sternum and the cartilages of the third, fourth, fifth, sixth, and seventh ribs of the left side,
in the Mediastinal cavity The Pericardial Sac consists of Fibrous Pericardium and Parietal Pericardium. The
external surface of the heart is also covered with a simple squamous serous membrane, the Visceral Pericardium
(Epicardium), beneath which is a thin layer of dense fibrous connective tissue and variable amounts of adipose
tissue which are superficial to the Myocardium itself. The Pericardial lining is a serous membrane which secretes
Pericardial Fluid

TOPOGRAPHY
In front, it is separated from the anterior wall of the thorax, in the greater part of its extent, by the Lungs and
Pleur; but a small area, somewhat variable in size, and usually corresponding with the left half of the lower
portion of the body of the Sternum and the medial ends of the cartilages of the fourth and fifth ribs of the left side,

Alya Putri Khairani / 130110220220 / B2

comes into direct relationship with the chest wall. The lower extremity of the Thymus, in the child, is in contact
with the front of the upper part of the Pericardium.
Behind, it rests upon the Bronchi, the Esophagus, the descending Thoracic Aorta, and the posterior part of the
Mediastinal surface of each lung.
Laterally, it is covered by the Pleur, and is in relation with the Mediastinal surfaces of the Lungs; the Phrenic
nerve, with its accompanying vessels, descends between the Pericardium and Pleur on either side

Alya Putri Khairani / 130110220220 / B2

STRUCTURE
The Fibrous Pericardium, an outer tough inelastic dense collagenous capsule, is the outermost layer, and it is
firmly bound to the central tendon of the Diaphragm. Extrapericardial fat, which may be visible radiographically, is
often found in the angles between the pericardium and diaphragm on each side. The pericardium is attached to the
sternum (by the Sternopericardial Ligaments) and is adherent to the Mediastinal Pleura except where the two are
separated by the Phrenic Nerves. The vessels receiving fibrous prolongations from this membrane are: the Aorta,
the Superior Vena Cava, the right and left Pulmonary Arteries, and the four Pulmonary Veins. The Inferior Vena
Cava enters the Pericardium through the central tendon of the diaphragm, and receives no covering from the
fibrous layer
The Serous Pericardium, an inner simple squamous serous membrane, is a closed sac. It consists of
a Visceral and a Parietal portion. The visceral portion, or Epicardium, covers the heart and the great vessels,
and from the latter is continuous with the parietal layer which lines the Fibrous Pericardium. The portion which
covers the vessels is arranged in the form of two tubes. The Aorta and Pulmonary Artery are enclosed in one tube,
the Arterial Mesocardium. The Superior and Inferior Ven Cav and the four Pulmonary Veins are enclosed in a
second tube, the Venous Mesocardium, the attachment of which to the parietal layer presents the shape of an
inverted U. The cul-de-sac enclosed between the limbs of the U lies behind the left atrium and is known as
the Oblique Sinus, while the passage between the venous and arterial mesocardiai.e., between the aorta and
pulmonary artery in front and the atria behindis termed the Transverse Sinus.
The transverse pericardial sinus is especially important to cardiac surgeons. After the pericardial sac has been
opened anteriorly, a finger can be passed through the transverse pericardial sinus posterior to the aorta and
pulmonary trunk. By passing a surgical clamp or placing a ligature around these vessels, inserting the tubes of a
coronary bypass machine, and then tightening the ligature, surgeons can stop or divert the circulation of blood in
these large arteries while performing cardiac surgery.

Alya Putri Khairani / 130110220220 / B2

The potential space between the parietal and visceral layers contains a thin film of fluid which lubricates the
surfaces as the heart twists during contraction with the pericardial sac and is known as the Pericardial Cavity

INNERVATION
Fibrous Pericardium and the Parietal layer of Serous
Pericardium are supplied by Phrenic Nerves. The
Visceral layer of Serous Pericardium has different
innervations than the parietal layer. It is innervated by
branches of Sympathetic Trunks and Vagus Nerves

VASCULARIZATION
Arterial Supply:

Musculophrenic Artery from Internal Thoracic Artery

Bronchial, Esophageal & Superior Phrenic Arteries

from Descending Thoracic Aorta

Coronary Artery
Venous Drainage:

Pericardiophrenic Vein

Azygos Venous System

References:
John T. Hansen, Netters Clinical Anatomy 2 nd Edition
Henry Gray, Grays Anatomy of The Human Body
http://www.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2020/2020%20Exam%20Reviews/Exam
%201/CH18%20Pericardial%20Cavity%20and%20Pathology.htm
http://www.dartmouth.edu/~humananatomy/part_4/chapter_23.html
http://www.mananatomy.com/body-systems/cardiovascular-system/pericardium