Izumi S, Beppu S, Matsuhisa M, Ohmori F, Park Y D, Nagata S, Kinoshita N, Miyatake K, Sakakibara H, Nimura Y
National Cardiovascular Center, Research Institute and Hospital, Suita.
J Cardiol. 1987 Mar;17(1):129-38.
Using pulsed Doppler echocardiography, the effects of postural change on the blood flow pattern in the superior vena cava and in the right ventricular inflow tract were investigated to evaluate the physiological role of the pericardium. Eight cases of left-sided pericardial defect and eight healthy subjects were examined. 1. Suppressed inflow into the right atrium during systole in left-sided pericardial defect was manifested as a reduction of the systolic wave (S) in the superior caval vein and impairment of the systolic shift of the tricuspid annulus. This suppression suggested unsatisfactory volume expansion in the right atrium due to the absence of negative intrapericardial pressure. 2. In left-sided pericardial defect, the right ventricular inflow pattern differed from the normal, most distinctly in the right lateral recumbent position, though the cardiac motion was nearly identical with that of the normal in this position. In this position, the ratio of the peak velocity of presystolic filling to that of rapid filling was increased, and the deceleration half time of rapid filling was prolonged. These findings indicated that the right ventricular rapid filling was retarded, and was compensated by the filling due to atrial contraction. It is assumed that right ventricular filling is influenced by hydrostatic pressure due to changes in posture in the absence of restriction by the pericardium. 3. It is concluded that the pericardium maintains negative intrapericardial pressure, so that each cardiac chamber is uniformly expanded for its filling, and that this function minimizes the influence of posture on cardiac hemodynamics.
采用脉冲多普勒超声心动图，研究体位改变对上腔静脉和右心室流入道血流模式的影响，以评估心包的生理作用。对8例左侧心包缺损患者和8例健康受试者进行了检查。1. 左侧心包缺损患者在收缩期右心房流入减少，表现为上腔静脉收缩波（S）降低以及三尖瓣环收缩期移位受损。这种抑制表明由于心包内负压缺失，右心房容量扩张不充分。2. 在左侧心包缺损患者中，右心室流入模式与正常情况不同，在右侧卧位时最为明显，尽管此时心脏运动与正常情况几乎相同。在此体位下，收缩前期充盈峰值速度与快速充盈峰值速度之比增加，快速充盈减速半衰期延长。这些发现表明右心室快速充盈受阻，并由心房收缩引起的充盈进行代偿。据推测，在没有心包限制的情况下，体位改变导致的静水压会影响右心室充盈。3. 得出的结论是，心包维持心包内负压，使每个心腔均匀扩张以进行充盈，并且该功能可将体位对心脏血流动力学的影响降至最低。
