Deep Dive Into Aortic Surgery: Visceral Pericardium—A Forgotten Layer

The visceral pericardium covers the heart and the great vessels. It is mentioned in embryology textbooks, but it is rarely described in surgical textbooks. It is a distinct layer that provides additional strength to the ascending aorta, especially in acute aortic dissection and impending rupture. In this video, I will dissect out the visceral pericardium wrapping around the ascending aorta in an eighty-three-year-old patient, undergoing mini-access ascending aortic and hemiarch replacement. 

The visceral pericardium terminates superiorly at the pericardial reflection. It is absent at the junction between the ascending aorta and the pulmonary trunk. Often, this is the area that appears most traumatized and bruised in acute type A aortic dissection, as the blood is barely contained by the visceral pericardium. Indeed, a forgotten layer, but the last line of defense.

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