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Ann Thorac Surg 1994;58:437-444
© 1994 The Society of Thoracic Surgeons

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Articles

Perioperative histologic and ultrastructural changes in the pericardium and adhesions

Royal Postgraduate Medical School, Hammersmith Hospital, London, England

Accepted for publication December 10, 1993.

^_* Address reprint requests to Mr Nkere, Department of Cardiothoraacic Surgery, Hammersmith Hospital, Second Floor, B Block, Du Cane Rd, London W12 OHS, England.

The presence of pericardial adhesions prolongs the operation time and increases the risk of serious damage to the heart and other major vascular structures during resternotomy. The reported incidence of such damage is 2% to 6%. Pericardial mesothelial cells exhibit fibrinolytic activity, and therefore have an actual or potential role in the breakdown of the fibrinous adhesions that serve as the initial scaffolding for the firm collagenous adhesions seen at reoperation. Ten patients undergoing primary cardiac procedures were studied to assess the morphologic changes that take place within the pericardium and to relate these to accompanying changes in the pericardial plasminogen activating activity. Samples were taken at 0,75, and 135 minutes after pericardiotomy. Compared with samples obtained at the time of pericardiotomy, those taken at 75 and 135 minutes demonstrated a significant progression in the mesothelial cell damage (p < 0.01), together with increasing evidence of pericardial inflammation (p < 0.01). The findings from electron microscope studies confirmed and supplemented these findings. Furthermore, compared with its initial levels (median, 2.06 IU/cm²; range, 1.28 to 6.48 lU/cm²), the plasminogen activating activity of pericardial biopsy specimens was significantly reduced at 75 minutes (median, 0.64 IU/cm²; range, 0.12 to 2.44 IU/cm²; p < 0.05), with some recovery at 135 minutes (median, 1.45 IU/cm²; range, 0.12 to 4.39 IU/cm²; p = 0.059). This study has revealed that, during cardiac procedures, the pericardium undergoes inflammatory changes with concomitant damage to its mesothelium, together with a reduction in the pericardial mesothelial fibrinolytic potential. These changes may be important factors contributing to the early development of pericardial adhesions.

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