Pericardial disease: diagnosis and management. ACR Appropriateness Criteria dyspnea-suspected cardiac origin. The term "post-pericardiotomy syndrome" was substituted for the previous "post-cardiotomy syndrome" after it was discovered that the syndrome can occur after the pericardium is opened even if no other cardiac structures are involved (eg, after surgery for bronchogenic lung carcinoma).
Recurrent cardiac tamponade secondary to postpericardiotomy syndrome.
This website also contains material copyrighted by 3rd parties. Usually, the patient is treated with non-operative treatment and includes the administration of NSAIDs such as aspirin.
Enforce strict bed rest until the fever has resolved and chest radiography and ECG reveal near baseline findings.Immediate pericardiocentesis is necessary to relieve life-threatening cardiac tamponade.A surgically created pericardial window may be necessary in patients with recurrent relapses after medical- and catheter-based therapy.
Tsang TS, Barnes ME, Hayes SN, et al. Bed rest alone may be adequate to treat mild cases.
Cantinotti M, Spadoni I, Assanta N, et al. Balloon pericardiotomy for recurrent pericardial effusions following fontan revision.
2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC). Repeated postpericardiotomy syndrome following a temporary transvenous pacemaker insertion, a permanent transvenous pacemaker insertion and surgical pericardiotomy. Recurrent pericarditis, cardiac tamponade and pericardial constriction. Patients cardiac tamponade may need drainage of the fluid … Gungor B, Ucer E, Erdinler IC.
/viewarticle/915680 American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography.
Unusual complications of epicardial pacemakers. Peters RW, Scheinman MM, Raskin S, Thomas AN. Wendelin G, Fandl A, Beitzke A. High-dose intravenous immunoglobulin in recurrent postpericardiotomy syndrome. Intravenous immunoglobulin therapy for refractory recurrent pericarditis. Imazio M, Cecchi E, Demichelis B, et al.
Webber SA, Wilson NJ, Junker AK, et al. Panel A shows a SSFP cine image. These patients may require a pericardial window.Patients whose conditions are refractory to medical management require transfer to a facility that has a pediatric cardiologist and/or pediatric cardiothoracic surgeon available.
The workup and treatment may continue on an outpatient basis if the patient is not hemodynamically affected, although close follow-up is warranted.Medical management includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs)Anecdotally, successful treatment of recurrent pericardial effusion has been described using a single high-dose of intravenous immunoglobulin in one patientInpatient care of patients with PPS is indicated in more severe cases, such as patients with symptoms and signs indicative of tamponade.
Steroids, nonsteroidal antiinflammatory agents, and colchicine have been used for the treatment of PPS. Vinit J, Sagnol P, Buttard P, Laurent G, Wolf JE, Dellinger A. Recurrent delayed pericarditis after pacemaker implantation: a post-pericardiotomy-like syndrome?. There are few studies which have unequivocally defined the risk factors that predispose to PPS. It is defined in presence of 2 of 5 criteria: 1) fever occurring at least one week after surgery without underlying infection 2) pleuritic pain, 3) pericardial rub 4) pleural effusion and 5) pericardial effusion (8). Hargreaves M, Bashir Y. Postcardiotomy syndrome following transvenous pacemaker insertion.
Postpericardiotomy syndrome: no evidence for a viral etiology. Guidelines on the diagnosis and management of pericardial diseases executive summary.
2001 This anti-inflammatory medication might be used, along with over-the-counter medications, to treat Dressler's syndrome. Subxiphoid pericardial drainage for pericardial tamponade. Post pericardiotomy syndrome (PPS) was first described in 1953 in patients who developed fever and pleuritic pain after undergoing mitral valve surgeryMRI images from a 55 year old male who developed postpericardiotomy syndrome after mitral valve repair. Zeltser I, Rhodes LA, Tanel RE, et al. Success with steroids for treatment of PPS is limited; in a randomized control trial among pediatric patients undergoing cardiopulmonary bypass, there was no benefit of intravenous methylprednisolone in preventing PPS10. PPS can also be caused after a trauma, a puncture of the cardiac or pleural structures, after percutaneous coronary intervention, or due to pacemaker or pacemaker wire placement. Determinants of the postpericardiotomy syndrome: a systematic review. Khandaker MH, Espinosa RE, Nishimura RA, et al. Wessman DE, Stafford CM. Cardiac magnetic resonance imaging diagnosis of a loculated pericardial effusion in a patient with a postpericardiotomy syndrome. Four-chamber echocardiographic view following emergent pericardiocentesis (800 mL removed) for clinical and echocardiographic evidence of cardiac tamponade. Imazio M, Brucato A, Ferrazzi P, et al, for the COPPS-2 Investigators. J Thorac Cardiovasc Surg.
[Guideline] Fardman A, Charron P, Imazio M, Adler Y. European guidelines on pericardial diseases: a focused review of novel aspects. This is a less invasive procedure in which a pericardial window is created in the catheterization laboratory using a balloon catheter under fluoroscopic guidance.Currently, there is no known preventative therapy available for postpericardiotomy syndrome.A randomized controlled trial evaluating the use of colchicine to prevent postpericardiotomy syndrome (PPS) in patients undergoing cardiopulmonary bypass did not find a statistically significant difference from placebo.Preliminary findings from the Colchicine for Prevention of the Postpericardiotomy Syndrome and Postoperative Atrial Fibrillation (COPPS) trial in adults indicated that compared with placebo, perioperative use of colchicine reduced the incidence of PPS but not of postoperative atrial fibrillation or postoperative pericardial/pleural effusion.In a systematic review of the literature for prophylaxis and treatment of PPS, Cantinotti et al found three major medication classes were used: nonsteroidal anti-inflammatory agents (NSAIDs), and colchicine.Andreev DA, Giliarov MIu, Syrkin AL, Udovichenko AE, Gerok DV.
Hoffman JIE, Stanger P. Diseases of pericardium. Diseases & Conditions Cardiac tamponade complicating postpericardiotomy syndrome.