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postpericardiotomy syndrome
Etiology:
- more common with cardiac surgery opening the pericardium
- more common after repair of tetralogy of Fallot, repair of atrial septal defect, ventricular septal defect & after cardiac transplantation
- may occur after myocardial infarction (Dressler syndrome)
- complication after percutaneous coronary intervention with coronary stent implantation
- after implantation of cardiac pacemaker leads
- after cardiac trauma [1]
Pathology:
- inflammatory reaction involving pericardium & pleura
- pericardial effusion may evolve to cardiac tamponade
- pleural effusion
Clinical manifestations:
- fever
- retrosternal chest pain (pericardial pain)
- pleuritic pain
- friction rub
- pneumonitis
- generally single episode, but may recur years later
Laboratory:
- pulse oximetry: oxygen saturation may be diminished
Special laboratory:
- electrocardiogram: electrical alternans
Radiology:
- chest X-ray for pleural effusion, pulmonary infiltration, pericardial effusion
Management:
- colchicine may reduce inflammation (first line) [2]
- does not reduce pericardial effusion [3]
- does not reduce pleural effusion [3]
- salicylates &/or glucocorticoids may reduce inflammation [4]
- opiates may reduce pain [4]
General
postoperative complication
pericardial disease
syndrome
References
- Horenstein MS, Berger S
Medscape: Postpericardiotomy Syndrome
http://emedicine.medscape.com/article/891471-overview
- Wikipedia: Postpericardiotomy syndrome
http://en.wikipedia.org/wiki/Postpericardiotomy_syndrome
- Imazio M et al
Colchicine for Prevention of Postpericardiotomy Syndrome and
Postoperative Atrial FibrillationThe COPPS-2 Randomized
Clinical Trial.
JAMA. Published online August 30, 2014
PMID: 25172965
http://jama.jamanetwork.com/article.aspx?articleid=1900482
- McClendon CE, Leff RD, Clark EB.
Postpericardiotomy syndrome.
Drug Intell Clin Pharm. 1986 Jan;20(1):20-3.
PMID: 3510843