Functions of the pericardial ligaments.Literature review.By Jon Trister MD
Function of the Ligaments Connected to the Pericardium
The ligaments connected to the pericardium—primarily the pericardiophrenic and sternopericardial ligaments—serve to anchor the fibrous pericardium to surrounding thoracic structures. Their main functions include:
- Fixation of the Heart: These ligaments tether the fibrous pericardium to the diaphragm (pericardiophrenic ligament) and to the posterior surface of the sternum (sternopericardial ligaments), thereby fixing the position of the heart within the mediastinum and limiting its motion during bodily movements.
- Stabilization: By anchoring the pericardium to the diaphragm and sternum, these ligaments prevent excessive displacement, torsion, or rotation of the heart, especially during changes in posture or respiration.
- Mechanical Support: The attachments help the pericardium maintain its shape and provide a stable environment for the heart, contributing to optimal cardiac function and protecting against sudden shifts that could compromise hemodynamics.
Are Pericardial Ligaments Damaged During Cardiac Surgery?
During cardiac surgery, especially procedures requiring access to the heart via median sternotomy or subxiphoid approaches, the pericardial ligaments may be cut or disrupted:
- Surgical Access: To expose the heart, surgeons often incise or bluntly dissect the fibrous pericardium and may need to divide the sternopericardial ligaments (anterior attachments to the sternum) and sometimes the pericardiophrenic ligament (inferior attachment to the diaphragm).
- Clinical Consequences: Disruption of these ligaments is generally well tolerated. Their primary role is to stabilize the heart, but after surgery, the heart remains supported by other mediastinal structures and adhesions that form during healing. There is no evidence that routine division of these ligaments during surgery leads to significant long-term complications.
- Complications: Most complications after cardiac surgery are related to pericardial injury itself (such as pericarditis, pericardial effusion, or tamponade) rather than specific damage to the pericardial ligaments25. Large or traumatic pericardial tears, however, can rarely result in cardiac displacement or herniation, but this is more relevant in the context of trauma than elective surgery.
Summary Table: Pericardial Ligament Functions and Surgical Impact
| Ligament | Attachment Site | Function | Damaged During Surgery? | Clinical Consequence if Damaged |
|---|---|---|---|---|
| Pericardiophrenic | Central tendon of diaphragm | Anchors heart inferiorly, limits movement | Often | Usually none; heart remains stable |
| Sternopericardial | Posterior surface of sternum | Anchors heart anteriorly | Often | Usually none; stability maintained |
Key Points
- The pericardial ligaments stabilize the heart by anchoring the fibrous pericardium to the diaphragm and sternum, limiting excessive movement.
- These ligaments are often divided during cardiac surgery to access the heart; this is routine and does not typically cause clinical problems36.
- Most post-surgical complications relate to the pericardial sac itself, not the ligaments.
- Rarely, extensive pericardial injury (as in trauma) can lead to cardiac displacement, but this is not a typical risk in controlled surgical settings.
In summary, the pericardial ligaments are essential for stabilizing the heart within the chest, and while they are frequently divided during cardiac surgery, this does not usually result in adverse outcomes due to compensatory support from surrounding tissues and postoperative adhesion.
