EFFECT OF PHYSICAL PROTECTION ON THE MESOTHELIAL INTEGRITY OF THE PERICARDIUM

Background. Mesothelial integrity is essential for the prevention of p ericardial adhesions. This study was performed to determine the effect of physical protection of the pericardium on mesothelial integrity. M ethods. A pericardial biopsy specimen was obtained at the time of peri cardiotomy (0 minutes) in 10 patients undergoing a cardiac operation f or the first time. The left free edge of the pericardiotomy was plicat ed inward to protect the mesothelium. Biopsy specimens were obtained f rom the protected and unprotected pericardium at 45 and 90 minutes aft er the start of extracorporeal circulation. Mesothelial integrity and the local inflammatory response were then assessed and graded histolog ically. Results. The mesothelium was found to be present in the protec ted specimens at 0, 45, and 90 minutes, but it was found to be denuded in the unprotected specimens (p = 0.003 at 45 minutes; p = 0.004 at 9 0 minutes). Local inflammation was totally established in both the pro tected and unprotected specimens at 45 minutes. Conclusions. Physical agents appear to be the main factor that is damaging to the pericardia l mesothelium, and this is an important concept to be taken into consi deration when designing a method to prevent pericardial adhesions. (C) 1997 by The Society of Thoracic Surgeons.