WHF Taskforce on Pericardial Diseases
A landmark publication in the field of pericardial disease:
“Pericardiology: Contemporary Answers to Continuing Challenges” 


 

Pericardiology: Contemporary answers to continuing challenges



Editors
Petar M. Seferovic, David H. Spodick and Bernhard Maisch


Associate editors
Ruzica Maksimovic and Arsen D. Ristic

Publisher:
Science, Bulevar revolucije 314/25
11000 Belgrade
Yugoslavia
ISBN 86-7621-059-4

For ordering, please contact Prof. Severovic:  eseferov@eunet.yu

Price:  180 DM (German Mark),  includes postage

Please transfer money to:
Account no. 001-33-046771
Cyprus Popular Bank
Nicosia Main Branch, Nicosia, Cyprus,
Beneficiary: Ecorex Overseas Ltd.
 
 

List of Contributors

NESTOR J. ANGOMACHALELIS, M.D., Ph.D., LL.B 
Professor of Cardiology and Pulmology, Aristotle University of Thessaloniki, School of Medicine. Department of Internal Medicine, George Papanikolaou Hospital, Thesaloniki, Greece

ANTONIO BAYÉS DE LUNA, M.D., Ph.D.

Professor of Cardiology, Free University of Barcelona. Director, Department of Cardiology and Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Free University of Barcelona, Barcelona, Spain

ANTONIO BAYÉS GENIS, M.D., Ph.D.

Cardiology fellow, Department of Cardiology and Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Free University of Barcelona, Barcelona, Spain

CARL M. BEAURLINE

Comedicus Inc., Vice President, Regulatory Affairs and Quality Assurance

PETAR DJUKIC, M.D., Ph.D.

Professor of Cardiac Surgery, University of Belgrade School of Medicine. Director, Cardiac Surgery, Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia

BRANISLAV GOLDNER, M.D., Ph.D.

Professor of Radiology, University of Belgrade School of Medicine. Director, Imaging Center, Clinical Center of Bežanijska kosa, Belgrade, Yugoslavia

JIM G. GRABEK, BS, MS

Comedicus Inc.

OLGA GURI, M.D.

Cardiology Fellow, Department of Cardiology and Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Free University of Barcelona, Barcelona, Spain

VLADIMIR KANJUH, M.D., Ph.D.

Academician of Serbian Academy of Sciences and Arts. Professor of Pathology, University of Belgrade School of Medicine, Belgrade, Yugoslavia

DIMITRIOS TH. KREMASTINOS, M.D., Ph.D.

Professor of Cardiology, Athens University School of Medicine. Director, Second Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece

ANDJELA KUŠIC - PAJIC, M.D., M.Sc.

Assistant Professor of Medicine, University of Belgrade School of Medicine. Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia

EDUARDO GUIMARAES LESSA, M.D.

Cardiology Fellow, Department of Cardiology and Cardiac Surgery. Hospital de la Santa Creu i Sant Pau, Free University of Barcelona, Barcelona, Spain

BERNHARD MAISCH, M.D.

Professor of Internal Medicine, Faculty of Medicine of the Philipps-University Marburg.

Director and Chairman, University Clinic of Internal Medicine and Cardiology, Marburg, Germany

RUŽICA MAKSIMOVIC, M.D., Ph.D.

Assistant Professor of Radiology, University of Belgrade School of Medicine, Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia

VESELIN MITROVIC, M.D.

Professor of Clinical Pharmacology, Faculty of Medicine of the Johann Wolfgang Goethe University Frankfurt, Max Plank Society for Clinical and Physiology Research, Kerckoff Clinic, Bad Nauheim, Germany

ALAINE MILLAIRE, M.D., Ph.D.

Senior cardiologist, Cardiologic Hospital, University of Lille, Lille, France

OLIVIER NUGUE, M.D.

Cardiologist, Cardiologic Hospital, University of Lille, Lille, France

BILJANA OBRENOVIC - KIRCANSKI, M.D., Ph.D.

Associate Professor of Medicine, University of Belgrade School of Medicine. Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia

MIODRAG OSTOJIC, M.D., Ph.D.

Corresponding Member of Serbian Academy of Sciences and Arts. Professor of Medicine, University of Belgrade School of Medicine. Director, Cardiology Clinic, Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia

SABINE PANKUWEIT, Ph.D.

Department of Internal Medicine-Cardiology, Marburg, Philipps University Marburg, Germany

RADICA PEŠIC - BEŠTIC, M.D., M.Sc.

Cardiologist, Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia

PREDRAG LJ. PETROVIC, M.D., Ph.D.

Professor of Cardiac Surgery, University of Belgrade School of Medicine. Director, Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia

PATTY J. RIEGER, RT(R)

Comedicus Inc.

ARSEN D. RISTIC, M.D., M.Sc.

Cardiologist, Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia

JOSE MARIA DOMINGUEZ DE ROZAS, M.D.

Chief of Coronary Care Unit, Department of Cardiology and Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Free University of Barcelona, Barcelona, Spain

DRAGANA SEFEROVIC, M.D.

Cardiologist, Institute for Cardiac Rehabilitation, University of Belgrade School of Medicine, Belgrade, Yugoslavia

PETAR M. SEFEROVIC, M.D., Ph.D.

Professor of Internal Medicine, University of Belgrade School of Medicine. Head, Department of Cardiology II, Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia. 

ARTURO RODRIGUEZ DE LA SERNA, M.D., Ph.D.

Associate Professor of Medicine, Free University of Barcelona. Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Free University of Barcelona, Barcelona, Spain

RALPH SHABETAI, M.D.

Professor of Medicine emeritus, University of California, San Diego. Staff cardiologist, San Diego Veterans Administration Hospital, San Diego, California

DEJAN SIMEUNOVIC, M.D.

Cardiology Fellow, Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade Yugoslavia

SLAVKO SIMEUNOVIC, M.D., Ph.D.

Professor of Pediatrics (Cardiology) and Vice-Dean for Science and International Affairs, University of Belgrade School of Medicine. Head, Department of Cardiology, University Children’s Hospital, Belgrade, Yugoslavia

JOSEP GUINDO SOLDEVILA, M.D. 

Cardiologist, Coronary Care Unit, Department of Cardiology and Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Free University of Barcelona, Barcelona, Spain

DAVID H. SPODICK, M.D., D.Sc.

Professor of Medicine, University of Massachusetts Medical School. Director of Clinical Cardiology and Cardiovascular Fellowship Training, Saint Vincent Hospital, Worcester, Massachusetts

SINIŠA STOJKOVIC, M.D., M.Sc.

Assistant Professor of Medicine, University of Belgrade School of Medicine. Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia

VUJADIN TATIC, M.D., Ph.D.

Professor of Pathology, Military Medical Academy. Head, Institute for Pathology and Forensic Medicine, Military Medical Academy, Belgrade, Yugoslavia

DANIJELA TRIFUNOVIC-ZAMAKLAR, M.D.

Cardiology Fellow, Institute for Cardiovascular Diseases, University Medical Center of Serbia, Belgrade, Yugoslavia


 
 

Under the editorship of the WHF Taskforce on Pericardial Diseases, Drs. Petar M. Seferovic, David H. Spodick, and Bernhard Maisch have edited a new major pubication in the field of pericardial diseases. The editors' and authors' intent was to provide a comprehensive guide for clinicians on diagnosis and therapy. The book  (508 pages) has 50 chapters organized in six major sections:
Some of the most outstanding authors in the field (36 contributors from 10 centers) are bring together an extensive up-to-date  knowledge of the normal and diseased pericardium. This volume provides a broad view on the current research and clinical efforts in the most prominent European and American centers specialized in pericardial disease.
A specific advantage of this book is the inclusion of the original work from several centers on pericardioscopy, pericardial biopsy, percutaneous balloon pericardiotomy, and the first clinical application of the new instrument for pericardial puncture, i.e. the PerDUCER®. Numerous full color pericardioscopy photos and original artistic illustrations render the text more comprehensive and easier to understand. Every chapter is followed by a bulleted summary, recommended readings, and a focus box where a controversial topic is elaborated in more detail.


Preface

 
S
cientific advances constantly necessitate fractionations within broad fields of investigation, practice and teaching. Thus, cardiology began to be differentiated as a specialty by 1920. After 1950 post World War II investments in basic and applied research, the rapid development of hemodynamics and imaging, and especially the more recent availability of echocardiography had several consequences: adding to basic knowledge; explaining incompletely understood aspects of cardiac and pericardial diseases; and revealing previously undiscovered diagnoses (e.g. hypertrophic and restrictive cardiomyopathies; valvular prolapse). Thus, in the second half of the twentieth century, general cardiologists have been increasingly complemented by colleagues who are also qualified in general cardiology, but have concentrated on special fields such as imaging, electrophysiology, interventional cardiology, “diastology” and clinical pharmacology.
Pericardiology, like so many other cardiologic specialties, justifies its particular designation by the rapidly increasing understanding and application of the pericardium’s unique characteristics: its histology and gross anatomy (the many pericardial recesses, for example, are absent at autopsy and only completely identifiable by magnetic resonance imaging); pericardial microphysiology: the function of the pericardial mesothelium as a veritable chemical factory providing active substances including those with a paracrine function; pericardial macrophysiology, including its effects upon the normal and diseased heart; and the pathophysiology of cardiac tamponade and constriction. All such advances facilitate the often difficult differential diagnoses of pericardial from cardiac disease, (e.g. acute pericarditis from acute myocardial infarction; constrictive pericarditis from restrictive cardiomyopathy). They also permit earlier diagnosis of most pericardial lesions and their prompt and appropriate management. A casein point is constrictive pericarditis, which in previous years was almost always referred to as “chronic constrictive pericarditis”. Today, its recognition in subacute and acute stages is much easier so that pericardiologists do not permit constriction to become chronic in the vast majority of cases.
Paralleling advances in basic and applied knowledge of the pericardium have been continuing challenges, to which this book is addressed. Many of these are classic challenges (like constriction) but their contexts and even their etiologies have evolved over the past few decades such that in any geographic area the “case mix” differs according to the pathogenesis of a particular lesion. Thus, in “advanced” countries, as tuberculosis is better controlled and eradicated it is becoming a much less common cause of constriction. In contrast, cardiac surgery has become a significant antecedent of constriction, although in a relatively small number of cases. This form often has a thin pericardium, which taxes the lower limits of imaging criteria. Yet it is diagnosable by its clinical, and especially its pathophysiological, effects. 
A possible “disease of medical progress” is recurrent and incessant idiopathic pericarditis (presumably originally viral in most cases), in which recurrences may depend on early exposure to a corticosteroid therapeutic agent. At the same time, advances in managing myocardial infarction, particularly thrombolysis, have dramatically decreased the incidence of epistenocardiac pericarditis and the Dressler’s syndrome seems almost to be vanishing. Modern immunology has begun to revolutionize the understanding of mechanism of these and other pericardial syndromes and also promises more rational approaches to treatment.

Advances in minimally invasive surgery, including video-assisted pericardioscopy, have increased the safety and reduced the morbidity of surgical approaches, particularly pericardial biopsy and minimally invasive resection of lesions. Similarly, imaging, particularly two-dimensional and Doppler echocardiography, and especially transesophageal echocardiography, have made classic percutaneous pericardial drainage almost perfectly safe.

The foregoing selected advances and expansions in various fields parallel the continuing challenges in pericardial disease and can be even better appreciated when one understands that the pericardium is involved in every category of disease. This involvement is sometimes clinically silent, but with frequently important diagnostic and therapeutic implications. Finally, direct access to the pericardium for treatment and diagnosis has been limited to patients with pericardial effusions and to treatment of their pericardial lesions. Recently the normal pericardium has been entered traumatically by catheter penetration of the right atrial appendage. Furthermore, there is some initial experience with almost atraumatic pericardial entry with an instrument (PerDUCER®) via the chest wall, making possible direct diagnosis and treatment of a wide range of structural heart and coronary disease and electrophysiologic abnormalities.

This book recognizing the dynamicity of both the continuing challenges and advances in diagnostics and therapeutics, offers solutions based on the best contemporary knowledge.

Petar M. Seferovic

David H. Spodick

Bernhard Maisch

 
 
Comments on Pericardiology:Contemporary answers to continuing challenges, by Ralph Shabetai, James B. Young, and Robert Roberts:


Ralph Shabetai, San Diego, California, USA

“The editors and authors intent was to provide a useful guide on this subject to clinicians. Pericardiology reviews the whole field of pericardial normal and abnormal structure and function and the major pericardial diseases and, where relevant, their effects on the heart and circulation.”


James B. Young, Cleveland, Ohio, USA 

„... an amazingly comprehensive overview of a problem that contiunes to fascinate. It is simply the most thorough review of the subject that I had seen. Congratulations on your perseverance.”


Robert Roberts, Houston, USA

“The book significantly enhances our understanding of all aspects of the pericardium and its interaction with normal physiology and myocardial disease. The European and American traditional views of the pericardium are seamlessly blended with the new scientific analytical observations. While former elusive functions of the pericardium have been elucidated by the authors, the background for future problems and their solutions have also been informatively crafted for the inquiring futuristic mind. It entwines observations from the new era of evidence-based medicine with clinical observations in an historical perspective. The novice and the veteran will both benefit greatly from indulging in the reading of this outstanding textbook.”
 

January 2, 2001