UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, California, USA.
Department of Surgery, UCLA, Los Angeles, California, USA.
JACC Clin Electrophysiol. 2021 Dec;7(12):1628-1644. doi: 10.1016/j.jacep.2021.09.008. Epub 2021 Nov 24.
The pericardium of the human heart has received increased attention in recent times due to interest in the epicardial approach for cardiac interventions to treat cardiac arrhythmias refractory to conventional endocardial approaches. To support further clinical application of this technique, it is fundamental to appreciate the living anatomy of the pericardial space, as well as its relationships to the surrounding structures. The anatomy of the pericardial space, however, is extremely difficult regions to visualize. This is due to its complex 3-dimensionality, and the "potential" nature of the space, which becomes obvious only when there is collection of pericardial fluid. This potential space, which is bounded by the epicardium and pericardium, can now be visualized by special techniques as we now report, permitting appreciation of its living morphology. Current sources of knowledge are limited to the dissection images, surgical images, and/or illustrations, which are not necessarily precise or sufficient to provide relevant comprehensive anatomical knowledge to those undertaking the epicardial approach. The authors demonstrate, for the first time to their knowledge, the 3-dimensional living anatomy of the pericardial space relative to its surrounding structures. They also provide correlative anatomy of the left sternocostal triangle as a common site for subxiphoid access. The authors anticipate their report serving as a tool for education of imaging and interventional specialists.
由于人们对通过心外膜途径治疗对传统心内膜途径无效的心律失常的兴趣，人类心脏的心包膜在最近受到了更多的关注。为了支持该技术的进一步临床应用，了解心包腔的活体解剖结构及其与周围结构的关系至关重要。然而，心包腔的解剖结构极难可视化。这是由于其复杂的三维结构，以及只有在心包积液积聚时才会变得明显的“潜在”空间。现在，我们可以通过特殊技术来可视化这个潜在空间，如我们现在所报告的，从而可以了解其活体形态。目前的知识来源仅限于解剖图像、手术图像和/或插图，但这些不一定准确或足以向进行心外膜途径的人提供相关的全面解剖学知识。作者首次展示了心包腔相对于周围结构的三维活体解剖结构。他们还提供了左侧胸骨肋三角的相关解剖结构，作为剑突下入路的常见部位。作者期望他们的报告可以作为影像学和介入专家教育的工具。
