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332 LETTERS TO THE EDITOR Downloaded from http://circres.ahajournals.org/ by guest on May 7, 2017 In the March Circulation Research, Glantz and colleagues' state that "virtually all contemporary studies of the heart's diastolic properties tacitly or explicitly treat the pericardium as a flaccid sack which encloses the heart and exerts important effects only at very large diastolic volume." Perhaps the term "contemporary studies" can now be defined as only those items that emerge from a computer search, but I would have thought that our article published in Circulation Research in 19652 had not yet been relegated to the historical bin. In a chronic study of pericardial pressures after recovery from surgery, we found that diastolic filling in the normal state amounted to 30% of the respiratory fluctuation, a sizeable change representing the finite capacity of the pericardial sack. Even earlier, Holt3 pointed out (also in Circulation Research) that the use of the pleural pressure for calculating the effective filling pressure for the ventricle would be erroneous when the ventricular end-diastolic pressure was elevated "in the slightest." As we showed, this includes the long filling interval of a normal sinus arrhythmia. Warren G. Guntheroth, M.D. Professor of Pediatrics Head, Division of Pediatric Cardiology University of Washington School of Medicine Seattle, Washington 98195 References 1. Glantz SA, Misbach GA, et al: The pericardium substantially affects the left ventricular diastolic pressure-volume relationship in the dog. Circ Res 42: 433, 1978 2. Morgan BC, Guntheroth WG, Dillard DH: Relationship of pericardial to pleural pressure during quiet respiration and cardiac tamponade. Circ Res 16: 493, 1965 3. Holt JP, Rhode EA, Kines H: Pericardial and ventricular pressure. Circ Res 8: 1171, 1960 Pericardial pressures. W G Guntheroth Downloaded from http://circres.ahajournals.org/ by guest on May 7, 2017 Circ Res. 1978;43:332 doi: 10.1161/01.RES.43.2.332 Circulation Research is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 1978 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7330. Online ISSN: 1524-4571 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circres.ahajournals.org/content/43/2/332.citation Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation Research can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation Research is online at: http://circres.ahajournals.org//subscriptions/
