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Postsurgical Intrapericardial Adhesions: Mechanisms of Formation and Prevention  Aldo Cannata, MD, Duccio Petrella, MD, Claudio Francesco Russo, MD, Giuseppe.

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Presentation on theme: "Postsurgical Intrapericardial Adhesions: Mechanisms of Formation and Prevention  Aldo Cannata, MD, Duccio Petrella, MD, Claudio Francesco Russo, MD, Giuseppe."— Presentation transcript:

1 Postsurgical Intrapericardial Adhesions: Mechanisms of Formation and Prevention 
Aldo Cannata, MD, Duccio Petrella, MD, Claudio Francesco Russo, MD, Giuseppe Bruschi, MD, Pasquale Fratto, MD, Marcello Gambacorta, MD, Luigi Martinelli, MD  The Annals of Thoracic Surgery  Volume 95, Issue 5, Pages (May 2013) DOI: /j.athoracsur Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Diagram shows the early steps for the formation of postsurgical intrapericardial adhesions: 1 = normal pericardial mesothelial cells, tightly adherent to the adjacent cells and the basal lamina, with a flattened shape and covered by microvilli on the luminal surface; 2 = rounded pericardial mesothelial cells, separated from the adjacent cells and the basal lamina, devoid of microvilli; 3 = rounded mesothelial cell free-floating into the pericardial cavity; 4 = fibrin accumulations along the areas devoid of both mesothelial cells and basal lamina with exposure of the submesothelial connective tissue; 5 = bundles of fibrin that fuse denuded areas of visceral and parietal pericardium; 6 = pericardial cavity. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Chart shows pathogenesis of postsurgical intrapericardial adhesions. Methods to prevent the formation of adhesions are reported within black boxes, and the dotted lines show their level of action within the pathogenetic mechanism. (HA = hyaluronic acid; PEG = polyethylene glycol; PMC = pericardial mesothelial cells.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Diagram shows the mechanism of action of sealants and resorbable membranes. A layer of product (1) impedes the adherence and accumulation of fibrin on the exposed submesothelial connective tissue along the epicardium (2), preventing the fusion between the visceral and parietal pericardium. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Calretinin antibody staining in this photomicrograph of a specimen from the anterior wall of the left ventricle, 1 year after treatment with Coseal, shows the integrity of the mesothelial cells along both the layers of the pericardium, without connective tissue between the visceral and parietal pericardium. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Photomicrograph shows a specimen from the inferior wall of the left ventricle, 1 year after operation and not treated with sealant. The space between the pericardial layers is filled by loose connective tissue of the adhesions. Hematoxylin and eosin stain. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

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