T he normal pericardium consists of 2 layers: a fibrous outer layer and a serous inner layer. The pericardial space is enclosed within these 2 layers and normally contains 20 to 50 mL of serous fluid. The pericardium serves a variety of functions. In addition to its mechanical effects on the heart (limiting distention, promoting chamber-coupling interaction, maintaining cardiac geometry, enabling frictionless movement, and serving as a barrier to infection), the pericardium has immunologic, vasomotor, paracrine, and fibrinolytic activities.

Primary pulmonary artery sarcoma has a poor prognosis. The surgical strategy at our institution included pneumonectomy, for possible radical resection, and palliative endarterectomy, to reduce symptoms and increase the life expectancy. The correct surgical approach must be evaluated individually, according to the tumor presentation, the presence of pulmonary hypertension, and the patient's clinical condition.

The clinical outcome of pericardiectomy for constrictive pericarditis is still marked by high operative mortality. Nevertheless, surgical treatment is able to improve the functional class in the majority of late survivors. Preoperative clinical conditions and associated comorbidities are crucial in predicting the risk of mortality, and early operation seems to be the most appropriate choice. The most suitable surgical strategy in cases of associated valvular operation remains to be determined.