Introduction

Hippocrates was perhaps the first physician-scholar to document the normal pericardium, as well as the fluid contained therein.[1] Centuries later, Galen described the pericardium as a protective structure for the heart. Although accounts of “hairy” hearts, which may be attributable to postmortem observations of pericardial adhesions, predated Galen, there is no evidence that the authors recognized the existence of the pericardium as a distinct anatomic structure. Understanding of the pericardium did not change appreciably for the next 1500 years until the first pericardiotomy was reportedly carried out in 1801 by Francisco Romero, who performed the operation through the left chest, grasping the pericardium with forceps and opening it with scissors by feel alone. He performed the procedure on 3 patients with long-term success in 2 cases, which may be comparable to modern results.[2] Nine years later, the more famous operation, and the one often credited as the first heart operation, was performed by Baron Dominique Larrey, the chief military physician to Napoleon. Larrey incised the pericardium in a soldier who had sustained a penetrating wound to the chest and developed purulent pericarditis.[3] In 1840 the first blind pericardiocentesis was performed by Franz Schuh, a pioneering pathologist and surgeon in Vienna. He placed a trocar through the fourth intercostal space into the pericardium of a 24-year-old woman with pericardial effusion, who was immediately relieved of her symptoms; she died 5 months later, and the autopsy demonstrated pericardial malignancy.[4] Of note, Schuh was the first physician in Austria to use ether as an anesthetic for surgical procedures.[5] As recognition of the condition increased, the association of a paradoxical pulse and of increased inspiratory jugular venous distension in constrictive pericarditis were reported by Adolph Kussmaul in 1873. Subsequently, the first pericardiectomies for constriction were performed by Ludwig Rehn in 1913 and Ferdinand Sauerbruch in 1925. These were primarily for tuberculosis related chronic pericarditis and for rheumatic fever, and utilized a lower hemisternotomy and an anterior pericardial resection. Constrictive pericarditis was later described as a complication of cardiac surgery after the first report of 3 cases was published in 1972 by Robert Marsa and colleagues.[6],[7]This chapter will discuss anatomy, congenital disorders, as well as acute and chronic pericardial disorders in the adults and their treatment.