In contrast, if there are no diaphragmatic adhesions, despite existing pericardial adhesions
in the upper parts of the heart, the above phenomenon may well be missed by freeing up the space caused by systolic shortening and elevation of the heart either by the expansion of the lung or even by a slight upward movement of the diaphragm.
The pathogenesis of such event is disputed and several hypotheses have been suggested, including type of cardioplegia , myocardial hypothermia , cardiopulmonary bypass , pericardial adhesions
, and the simple opening of the pericardium .
As there is increased systemic venous return to the right heart during inhalation, there is accentuated inhalational flattening or leftward deviation of the interventricular septum, a finding which in the appropriate clinical context has been reported to have a near 100% specificity and positive predictive value.(14, 15) Cine MR tag sequences in axial or four-chamber long axis orientation with tag lines perpendicular to the pericardium will demonstrate bending or persistent continuity of tag lines in patients with pericardial adhesions
or CP (Figure 7).