Microphysiology of the pericardium: Substrate for intrapericardial therapeutics

Recent capability to enter the normal effusion-free pericardium has expande d intrapericardial therapy which was formerly restricted to patients with e ffusive pericardial disease, to intrapericardial treatment of cardiac disea ses of all kinds. It is now possible to deposit in the intact pericardium a variety of therapeutic agents targeting the myocardium, valves, conduction system and even the endocardium. In addition to such specific agents, the unique microphysiology of the pericardial mesothelium provides investigator s with 2 entirely new applications of intrapericardial therapy: 1, suppleme nting substances like prostanoids and a variety of immune factors, and 2. s timulating pericardial production of such products of metabolism, e. g., su perfusion of the normal pericardium by non-steroidal antiinflammatory agent s to stimulate prostanoid production with a variety of effects including po ssible inhibition of coronary thrombosis. Continuing research and developme nt should determine the precise roles of these new applications in human me dicine.