Pericardial Influences on the Right Heart

  • Ralph Shabetai
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 83)


In this chapter the important structural features of the pericardium that influence the anatomy and function of the right ventricle will be summarized. The subject of ventricular interaction will be dealt with only in so much as it is modulated by the pericardium, other aspects of this subject being covered by Dr. Smith and Tyberg in Chapter 3. Likewise, since certain aspects of infarction of the right ventricle may bear a striking resemblance to chronic constrictive pericarditis, this subject will not be dealt with in detail because it is the subject of Chapter 6 by Dr. Isner. The complex shape of the right ventricle complicates analysis of the influence of the pericardium on its size and function. The reader of this chapter therefore needs familiarity with the material contained in the first chapter of this book.


Cardiac Tamponade Constrictive Pericarditis Respiratory Variation Ventricular Free Wall Pulsus Paradoxus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Holt JP, Rhode EA, Kines H: Pericardial and ventricular pressure. Circ Research 8:1171–1181, 1960.Google Scholar
  2. 2.
    Hess OM, Bhargava V, Ross J Jr, Shabetai R: The role of the pericardium in interactions between the cardiac chambers. Am Heart J 106:1377–1383, 1983.PubMedCrossRefGoogle Scholar
  3. 3.
    Lee MC, LeWinter ML, Freeman G, Shabetai R, Fung YC: Biaxial mechanical properties of the pericardium in normal and volume overload dogs. Am J Physiol 249:H222–H230, 1985.PubMedGoogle Scholar
  4. 4.
    Lee JM, Bouchner DR: Tissue mechanics of canine pericardium in different environments. Circ Res 49:453–544, 1981.Google Scholar
  5. 5.
    Rabkin SW, Berghause DG, Bauer HF: Mechanical properties of isolated canine pericardium. J Appl Physiol 36:69–73, 1974.PubMedGoogle Scholar
  6. 6.
    Martin CJ, Hilderbrandt JH, Fukaya H: Stress-strain relations of tissue sheets undergoing uniform two dimensional stretch. J Appl Physiol 27:758–762, 1969.PubMedGoogle Scholar
  7. 7.
    Rabkin SW, Hsu PH: Mathematical and mechanical modeling of stress-strain relationship of pericardium. Ain} Physiol 229:896–900, 1975.Google Scholar
  8. 8.
    Lee JM, Bouchner DR: Mechanical properties of human pericardium: Differences in viscoelastic response when compared with canine pericardium Circ Res 55:475–481, 1985.Google Scholar
  9. 9.
    Wiegner AW, Bing OH, Borg TK, Caulfield JB: Mechanical and structural correlates of canine pericardium. Circ Res 49:807–814, 1981.PubMedGoogle Scholar
  10. 10.
    Yen F, personal communication.Google Scholar
  11. 11.
    Lee MC, Fung YC, Shabetai R, LeWinter MM: Biaxial mechanical properties of the human pericardium. Circ Res, in press, 1986.Google Scholar
  12. 12.
    Mann D, Lew W, Ben-Hayashi E, Shabetai R, Waldman L, LeWinter MM: In vivo mechanical behavior of canine pericardium. Am J Physiol, in press, 1986.Google Scholar
  13. 13.
    Mangano DT, Van Dyke, Hickey RF, Ellis RJ: Significance of the pericardium in human subjects: Effects on left ventricular volume, pressure and ejection. J Am Coll Cardiol 6:290–295, 1985.PubMedCrossRefGoogle Scholar
  14. 14.
    Tyson GS, Maier GW, Olsen Co, Davis JW, Rankin JS: Pericardial influences on ventricular filling in the conscious dog. An analysis based on pericardial pressure. Circ Res 54:173–184, 1984.PubMedGoogle Scholar
  15. 15.
    Assanelli D, Lew W, LeWinter M: Comparative effects of pericardiectomy on left and right ventricular pressure-segment length relations. J Am Coll Cardiol 7 (Suppl 2):205A, 1986 (abstract).Google Scholar
  16. 16.
    Smiseth OA, Frais MA, Kingma I, Smith ER, Tyberg JV: Assessment of pericardial constraint in dogs. Circulation 71:158–164, 1985.PubMedCrossRefGoogle Scholar
  17. 17.
    Hoit B, Lew W, LeWinter M: Regional variation in pericardial contact pressure. Am Coll Cardiol 7:205A, 1986 (abstract).Google Scholar
  18. 18.
    Prindle KH, Gold HK, Beiser GD, Marcus ML, Epstein SE: Influence of pericardiectomy on cat right ventricular function after pulmonary arterial constriction. Am J Cardiol 31:260–264, 1973.PubMedCrossRefGoogle Scholar
  19. 19.
    Starr I, Jeffers WA, Meade RH Jr: The absence of conspicuous increments of venous pressure after severe damage to the right ventricle of the dog with a discussion of the relation between clinical congestive heart failure and heart disease. Am Heart} 26:291–301, 1943.CrossRefGoogle Scholar
  20. 20.
    Tani M: Role of the right ventricular free wall and ventricular septum in right ventricular performance and influence of the parietal pericardium during right ventricular failure in dogs. AmJ Cardiol 52:196–202, 1983.CrossRefGoogle Scholar
  21. 21.
    Barde SH, Hermann HJ: Acute mitral regurgitation in man. Hemodynamic evidence and observations indicating an early role for the pericardium. Circulation 36:839–851, 1967.Google Scholar
  22. 22.
    Freeman G, LeWinter MM: Role of the parietal pericardium in acute mitral regurgitation in dogs. Am J Cardiol 54:217–219, 1984.PubMedCrossRefGoogle Scholar
  23. 23.
    Boltwood CM, Shah PM: The pericardium in health and disease. Current Problems in Cardiology 9:10–62, 1984.CrossRefGoogle Scholar
  24. 24.
    Janicki JS, Weber KT: The pericardium and ventricular interaction, distensibility and function. Am J Physiol 238:H494–HSO3, 1980.PubMedGoogle Scholar
  25. 25.
    Glantz SA, Misbach GA, Moores WY, Mathey DG, Lekven J, Stowe DF, Parmley WW, Tyberg JV: The pericardium substantially affects the left ventricular diastolic pressure-volume relationship in the dog. Circ Res 42: 433–441, 1978.PubMedGoogle Scholar
  26. 26.
    Fowler NO, Shabetai R, Braunstein JR: Trans-mural ventricular pressures in experimental cardiac tamponade. Circ Res 7:733–739, 1959.PubMedGoogle Scholar
  27. 27.
    Shabetai R, Fowler NO, Guntheroth WG: The hemodynamics of cardiac tamponade and constrictive pericarditis. AmJ Cardiol 26:480–489, 1970.CrossRefGoogle Scholar
  28. 28.
    Craig RJ, Whalen RE, Behar VS, McIntosh HD: Pressure and volume changes of the left ventricle in acute pericardial tamponade. Am J Cardiol 22:65–74, 1968.PubMedCrossRefGoogle Scholar
  29. 29.
    Grose R, Greenburg M, Steingart R, Cohen MV: Left ventricular volume and function during relief of cardiac tamponade in man. Circulation 66:149–155, 1982.PubMedCrossRefGoogle Scholar
  30. 30.
    Ditchey R, Engler R, LeWinter MM, Pavelec R, Bhargava V, Covell J, Moores W, Shabetai R: The role of the right heart in acute cardiac tamponade in dogs. Circ Res 48:701–710, 1981.PubMedGoogle Scholar
  31. 31.
    Fowler NO, Gabel M: The hemodynamic effects of cardiac tamponade: Mainly the result of atrial not ventricular compression. Circulation 71: 154–157, 1985.PubMedCrossRefGoogle Scholar
  32. 32.
    Shabetai R, Fowler NO, Fenton JC, Masangkay M: Pulsus paradoxus. J Clin Invest 44:1882–1898, 1965.PubMedCrossRefGoogle Scholar
  33. 33.
    Schiller NB, Botvinick EH: Right ventricular compression as a sign of cardiac tamponade. An analysis of echocardiographic ventricular dimensions and their clinical implications. Circulation 56:774–779, 1977.PubMedGoogle Scholar
  34. 34.
    Shabetai R, Mangiardi L, Bhargava V, Ross J Jr, Higgins CB: The pericardium and cardiac function. Progress in Cardiovasc Disease 22:107–133, 1979.CrossRefGoogle Scholar
  35. 35.
    Lendrum BL, Monokar AM, Harris JB, Smulevitz B, Carr I: Respiratory variation in echocardiographic dimensions of left and right ventricles in normal children. The role of the interventricular septum. Pediatric Cardiology 1:39–45, 1979.CrossRefGoogle Scholar
  36. 36.
    Brenner JI, Waugh RA: Effect of phasic respiration on left ventricular dimensions and performance in a normal population. Circulation 57: 122–127, 1978.PubMedGoogle Scholar
  37. 37.
    Brinker JA, Weiss JL, Lappe DL, Rabson JL, Summer WR, Permutt S, Weisfeldt ML: Leftward septal displacement during right ventricular loading in man. Circulation 61:626–633, 1980.PubMedGoogle Scholar
  38. 38.
    Settle HP, Adolph RJ, Fowler NO, Engel P, Arguss NS, Levenson NI: Echocardiographic study of cardiac tamponade. Circulation 56:951–959, 1977.PubMedGoogle Scholar
  39. 39.
    Katz LN, Gauchat HW: Observations on pulsus paradoxus (with special reference to pericardial effusions). Arch Int Med 33:371–393, 1924.Google Scholar
  40. 40.
    Dornhorst AC, Leathart GL: Pulsus paradoxus. Lancet 1:746–748, 1952.PubMedCrossRefGoogle Scholar
  41. 41.
    Cohn JN, Pinkerson AL, Tristani FE: Mechanism of pulsus paradoxus in clinical shock. J Clin Invest 46:1744–1755, 1967.PubMedCrossRefGoogle Scholar
  42. 42.
    Goldblatt A, Harrison DC, Glick G, Braunwald E: Studies on cardiac dimensions in intact un-anesthetized man. Circ Res 13:455–460, 1963.Google Scholar
  43. 43.
    Hoit B, Sahn DJ, Shabetai R: Doppler-detected paradoxus of mitral and tricuspid valve flows in chronic lung disease. JACC 8:706–709, 1986.PubMedGoogle Scholar
  44. 44.
    Settle HP, Jr, Engel P, J, Fowler NO, Allen JM, Vassallo CL, Hackworth JN, Adolph RJ, Eppert DC: Echocardiographic study of the paradoxical arterial pulse in chronic obstructive lung disease. Circulation 62:1297–1307, 1980.PubMedGoogle Scholar
  45. 45.
    Gilliam LD, Guyer D, Gibson TC, King ME, Marshall J, Wyman AE: Hemodynamic compression of the right atrium: A new echocardiographic sign of cardiac tamponade. Circulation 68:294–301, 1983.CrossRefGoogle Scholar
  46. 46.
    Martin RP, Rakowski H, French J, Popp RL: Localization of pericardial effusion with wide angle phased array echocardiography. Am J Cardiol 42:904–912, 1978.PubMedCrossRefGoogle Scholar
  47. 47.
    Armstrong WF, Schilt BF, Helper DJ, Dillon JC, Feigenbaum H: Diastolic collapse of the right ventricle with cardiac tamponade: An echocardiographic study. Circulation 65:1491–1496, 1982.PubMedCrossRefGoogle Scholar
  48. 48.
    Leimbgruber PP, Klopfenstein S, Wann SL, Brooks HL: The hemodynamic derangement associated with right ventricular diastolic collapse in cardiac tamponade: An experimental echo-cardiographic study. Circulation 68:612–620, 1983.CrossRefGoogle Scholar
  49. 49.
    Klopfenstein S, Schuchard GH, Wann SL, Palmer TE, Hartz AJ, Gross CM, Singh S, Brooks HL: The relative merits of pulsus paradoxus and right ventricular diastolic collapse in the early detection of cardiac tamponade: An experimental echocardiographic study. Circulation 71:829–833,1985.PubMedCrossRefGoogle Scholar
  50. 50.
    Klopfenstein S, Cogswell TL, Bernath GA, Wann S, Tipton RK, Hoffman RG, Brooks H, Janzer DJ, Peterson DM: Alterations in intravascular volume affect the relation between right ventricular diastolic collapse and the hemodynamic severity of cardiac tamponade. JACC 6:1057–1063, 1985.PubMedGoogle Scholar
  51. 51.
    Singh S, Wann S, Schuchard GH, Klopfenstein SH, Leimgruber PP, Keelan MH, Brooks H: Right ventricular and right atrial collapse with cardiac tamponade: A combined echocardiographic and hemodynamic study. Circulation 70:966–971, 1984.PubMedCrossRefGoogle Scholar
  52. 52.
    Hansen AT, Eskildsen P, Gotzsche H: Pressure curves from the right atrium and right ventricle in chronic constrictive pericarditis. Circulation 3:881–888, 1951.PubMedGoogle Scholar
  53. 53.
    Marsa R, Mehta S, Willis W, Bailey L: Constrictive pericarditis after myocardial revascularization. Report of three cases. AmJ Cardiol 44:177–183, 1979.CrossRefGoogle Scholar
  54. 54.
    Schrire V, Gotsman MS, Beck W: Unusual diastolic murmurs in constrictive pericarditis and constrictive endocarditis. Am Heart J 76: 4–12, 1968.PubMedCrossRefGoogle Scholar
  55. 55.
    McGaff GJ, Haller JA Jr, Leight L, Towery BT: Subvalvular pulmonary stenosis due to constriction of the right ventricular outflow tract by a pericardial band. AmJ Med 34:142–146, 1963.CrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1988

Authors and Affiliations

  • Ralph Shabetai

There are no affiliations available

Personalised recommendations