part in blood supply of pericardium

41 
blood due to coronal arteries. There are many inosculations 
(anastomoses) between vessels of internal and external 
laminae of pericardium. This fact was used by cardiac surgeons 
to improve blood supply of myocard in chronic coronary 
insufficiency (operative treatment according to method of 
Fieschi – internal thoracic artery ligature in 2nd intercostal 
space, 
lower 
from 
the 
level 
of 
origin 
of 
a. 
pericardiacophrenica). 
The drainage of venous blood from pericardium is provided 
by the veins of the same name. 
The lymph is drained from pericardium to nodi lymphatici 
prepericardiaci, nodi lymphatici pericardiales laterales, nodi 
lymphatici parasternales, nodi lymphatici tracheobronchiales, 
nodi lymphatici juxtaoesophageales and nodi lymphatici 
prevertebrales. 
The pericardium is innervated due to cordial, aortal, 
pulmonary and esophageal nervous plexuses which are 
formed by means of branches of n. vagus, n. phrenicus, n. 
intercostalis and thoracic part of truncus sympathicus. They 
widely inosculate together. Those anastomoses are the reason 
of pain and reflexory muscular strain in damage or disease of 
pericardium what sometimes leads to improper laparotomy. 
In inflammation of the parietal and visceral pericardium 
(pericarditis), the large amount of liquid accumulates in 
pericardial cavity what leads to acute cardiac tamponade. 
The acute cardiac tamponade is observed when the heart is 
damaged. The symptoms of the acute cardiac tamponade 
(Beck’s triad) are: low blood pressure, fast and considerable 
increase in central venous pressure and absence of palmus 
during roentgenoscopy of thoracic cavity organs. On ECG – 
abnormality of cardiac rhythm. In such cases the 
pericardiocentesis is performed. 

42 
The long-term effusion in pericardial cavity may cause the 
adherent pericardium which leads to the heart compression 
and dysfunction. In these cases the puncture and 
catheterization don’t lead to any positive outcome. The 
pericardiotomy with cardiolysis is necessary. 

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