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This book is not about clear cases of acute and chronic pericarditis, but about unresolved issues not covered by current clinical guidelines that frequently create unexpected difficulties in the management of the disease in routine clinical practice. Here we discuss different kinds of diagnostic management from conventional echocardiography to advanced visualization procedures, such as magnetic resonance imaging and biopsy procedures, with the aim of clearly elucidating novel approaches to establishing the presence of the disease, predicting its natural course and determining its management. Although pericarditis of unknown etiology is frequently encountered in clinical practice, specific serological markers and culture tests are not regarded as final decision tools to thoroughly establish plausible causes of the disease in patients without clear backgrounds, signs and symptoms of heart failure, and concomitant conditions. In this respect, endocardial and pericardial biopsy, combined visualization procedures, such as contrast-enhanced magnetic resonance imaging with 3D-computer tomography modeling of cardiac function, are the next steps in contemporary management. The surgical approach, along with clear descriptions of patients' enrollment and predicted outcomes, are also described in this book.

Pericardium --- Diseases.

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Pericardium. --- Thoracic Surgery. --- Chest --- Pericardium --- Surgery. --- Surgery.

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Analyse des facteurs prédictifs de mortalité et de réoperation chez les malades opérés de pathologie mitrale avec uti lisation de péricarde bovin ou autologue lors de la plastie mitrale.Méthode : Entre le 09/02/ 1998 et le 22/ 12/2010 1697 patients ont été opérés de leurs valves mitrales et,ou tricuspides aux Cliniques universitaires Saint-Luc. 125 patients étaient concernés par une réparation de leur valve mitrale avec utilisation de péricarde bovin ou autologue. La population était âgée de 61 ans en moyenne et composée de 53.6% de femmes, les stades NYHA III + IV représentaient 36.8% des patients, 10.4% avaient du diabète, 28.8% de l'hyperchole stérolémie, 52.8% de l'HTA, 29.6% consommaient du tabac, 1 1.2% avaient des ATCD familiaux et 30.5% étaient en FA. L'étiologie principale était l'endocardite avec 42.4% des patients concernés. La FE était en moyenne de 59.6% +!- 13. Le suivi de follow-up était en moyenne de 66.14 mois +/- 48.2.Résultats :Il y a eu 13 décès endéans les 30 premiers jour s (mortalité opératoire) et 26 après ces 30 jours (mortalité tardive). Le groupe NYHA III + IV ne représente plus que 15% des patients il s'est donc nettement réduit après l'intervention .L'âge est le principal facteur qui influence la survie des patients, l 'autre facteur qui influence leur survie est la polymédication (prise de plus de 2 médicaments). En ce qui concerne la réopération aucun des facteurs de risque étudiés n'a été clairement mis en évidence. Cependant la régression de COX a montré que la prise de certains médicaments (diurétiques, honnones thyroïdiennes, hypoglycémiants oraux) serait liée à un risque plus élevé de réopération . La survie à 5 ans est de 71.5% +/- 4.5 et à 10 ans de 56.2% +/- 5.9. En ce qui concerne la survie sans réopérat ion elle est de 68.1% + - 4.7 à 5 ans et de 46.3% +/- 6.1. Par ailleurs il n'y a pas non plus de différence statistique entre la survie des patients opérés pour une plastie mitrale sans patch versus avec patch et entre les remplacements de la valve mitrale et les plasties avec utilisation de péricarde.Conclusion :La plastie mitrale avec utilisation de péricarde bovin ou autologue reste une excellente alternative dans la prise en charge des patients avec une IM associée à une restriction du tissu valvulaire, de l'anneau mitral ou de l'appareil sous-valvulaire. La prise en charge devra se faire par la chirurgie car c'est le seul traitement qui diminue la mortalité et la symptomatologie au long terme. Les facteurs de risque devront être pris en charge et suivis chez les patients concernés, ces éléments entreront dans la décision du type d'intervention et de traitement à entreprendre. Analysis of predictive factors of mortality and reoperation in patients operated for mitral pathology with the use of autologous or bovine pericardium during mitral plastic surgery. Method: Between 09/02/1998 and 22/ 12/2010 1697 patients underwent mitral valves surgery and/or tricuspid in 'Cliniques Universitaires Saint-Luc. In total 125 patients underwent mitral valve repair with use of bovine or autologous pericardium . The population were 61 years old on average and with 53.6% of women. NYHA stage III + IV accounted for 36.8% of patients, 10.4% had diabetes, 28.8% hypercholesterolem ia, 52.8% of hypertension, 29.6% consumed tobacco, 11.2% had family antecedents and 30.5% were in FA. The main aetiology was endocarditis with 42.4% of the patients affected. The EF averaged 59.6% +/- 13. The follow-up session averaged 66.14 months +/- 48.2. Results: There were 13 deaths within the first 30 days (operative mortality) and 26 after 30 days (late mortality). The NYHA III + IV group represents only 15% of the patients and is therefore significantly reduced after surgery. Age is the main factor influencing patient survival, the other one being polypharmacy (use of more than two drugs). Conceming the reoperation no risk factors studied have clearly been highlighted. However COX regression showed that taking certain drugs (diuretics, thyroid hormones, oral hypoglycemic agents) might be linked to a higher risk ofreoperation. Inone hand the 5-year survival is 71.5% +/- 4.5 and the 10-year survival is 56.2% +/- 5.9. On the other hand the survival without reoperation is +/- 4.7 68.1% at 5 years and 46.3% +/- 6.1 at 10 years. Moreover there is also no statistical difference in the survival of patients undergoing mitral valve plasty with patch and mitral valve plasty without patch. Furthermore mitral valve replacements and mitral valve plasties with use of pericardium shows similar results. Conclusion: Mitral valve plasty using bovine or autologous pericardium remains an excellent alternative in the treatment of patients with MI associated with valvular tissue, mitral annulus or subvalvular apparatus restrictions. Their management will have to be surgical due to the fact that it is the only treatment reducing mortality and Jong-term symptomatology. Risk factors will need to be addressed and followed-up in the patients affected; these elements will influence the decision on the type of intervention and treatment to be undertaken.

Pericardium --- Transplantation, Autologous --- Surgical Procedures, Operative

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The mesothelium is composed by a single layer of mesothelial cells that vest the serosal cavities (pleural, peritoneal and pericardial) and internal organs of the body. The mesothelial cells have a mixed phenotype of epithelial cells and fibroblasts rendering them remarkable plasticity. Besides providing a slippery surface for the frictionless movement of internal organs, the mesothelium participates in a wide range of physiological and pathophysiological processes. Some of its functions include lung development, trans-cellular and para-cellular transport of ions and water, secretion of glycoproteins (mainly hyaluronan), secretion of cytokines and growth factors, wound healing, response to inflammatory stimuli and induction of inflammation, mesothelial to mesenchymal transition and formation of tunneling nanotubes. Many of these functions are pivotal to physiological conditions such as respiratory development, maintenance of steady volume of serosal fluids and serosal permeability, cell-to-cell communication, re-mesotheliazation of serosal membranes after mechanical (e.g. by asbestos or nanoparticles) or inflammatory injury and participation in immune responses. Deviation from the physiological threshold of these functions results in the development of serosal effusions, induction of serosal and lung fibrosis, induction of mesothelial tumorigenesis, leading thus to devastating pathologies. Treatment of pathologies like mesothelioma, pleural and peritoneal fibrosis (in cases of patients under Peritoneal Dialysis) or lung fibrosis still pose a great challenge for researchers.

Mesothelium --- Serosal Membranes --- Physiology --- Pleura --- Peritoneum --- Pericardium

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Often times the symptoms of pericardial disease such as fever, chest pain, and shortness of breath are non-specific, making an accurate diagnosis a challenging task. Now, you can detect and treat pericardial disease in time to save many more patients. This title in the brand-new Clinical Diagnostic Imaging Atlas Series offers you authoritative guidance from a well-known cardiologist and imaging expert about when and how to perform the latest diagnostic imaging tests, interpret the results, and effectively treat the emergency. Detailed discussions of hot topics, full-color illustrations, animat

Physical methods for diagnosis --- Pericardium --- Heart --- Diseases --- Diagnosis --- Imaging