Postpericardiotomy syndrome: Difference between revisions

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{{CMG}} {{AE}} {{NE}}
{{CMG}} {{AE}} {{NE}}


{{SK}}Postcommissurotomy syndrome; PCS; PPS;Dressler syn;post cardiac injury syndrome;post heart injury syndrome;post pericardial injury syndrome
{{SK}}[[Posaconazole (patient information)|Postcommissurotomy]] syndrome; [[PCSK4|PCS]]; PPS; [[Dressler syndrome|Dressler syn]]; [[Post cardiac arrest syndrome|Post cardiac injury syndrome; Post heart injury syndrome; Post pericardial injury syndrome]]


==Overview==
==Overview==
The postpericardiotomy syndrome is inflammation of the [[pericardium]] (the sac surrounding the heart) following [[cardiac surgery]]. Symptoms can occur from days to weeks after the operation. The syndrome is thought to have an [[autoimmune]] basis.
The [[Postperfusion syndrome|postpericardiotomy]] syndrome is inflammation of the [[pericardium]] following [[cardiac surgery]]. [[Symptom|Symptoms]] can occur from days to weeks after the operation. The syndrome is thought to have an [[autoimmune]] basis. [[P-type ATPase|Postcardiac injury]] was first discovered by soloff, in 1953. Later Itoh in 1958 ,was first discovered same syndrome and labelled it [[Poa pratensis|postpericardiotomy syndrome]]. In 1956, Dressler described [[PMIS|PMIS,]] and therefore referred to as [[Dressler's syndrome|Dressler]] syndrome. It has been postulated that the syndrome is an [[autoimmune]] response to [[Pericardial Disease|pericardial]] and/or [[pleural]] bleeding or surgical trauma. Persistance of  Various viral agents,such as [[coxsackie B]], [[adenovirus]], and [[cytomegalovirus]] ,suggesting [[Autoimmune regulator|autoimmune response]] associated with a [[viral infection]]. It is thought that [[P-ATPase|postpericardiotomy syndrome]] is mediated by development of [[antibodies]] againts heart. The progression to [[P-type ATPase|postpericardiotomy syndrome]]  usually secondary to [[cell-mediated immunity]].


==Historical Perspective==
==Historical Perspective==


*Postcardiac injury syn  was first discovered by soloff, in 1953.
* [[P-type ATPase|Postcardiac injury]] was first discovered by Soloff, in 1953.
*Later Itoh in 1958 ,was first discovered same syndrome and labelled it postpericardiotomy syndrome.
* Later Itoh in 1958, was first discovered the same syndrome and labeled it [[Poa pratensis|postpericardiotomy syndrome]].
*In 1956, Dressler described PMIS , and therefore referred to as Dressler syndrome.
* In 1956, Dressler described [[PMIS|PMIS]], and therefore referred to as [[Dressler's syndrome|Dressler]] syndrome.


==Classification==
==Classification==
There is no established system for the classification of postpericardiotomy syndrome.
There is no established system for the classification of [[Concussion|postpericardiotomy syndrome]].


==Pathophysiology==
==Pathophysiology==
*It has been postulated that the syndrome is an [[autoimmune]] response to pericardial and/or pleural bleeding or surgical trauma.  
*It has been postulated that the syndrome is an [[autoimmune]] response to [[Pericardial Disease|pericardial]] and/or [[pleural]] bleeding or surgical trauma.
*Persistance of  Various viral agents,such as [[coxsackie B]], [[adenovirus]], and [[cytomegalovirus]] ,suggesting autoimmune response associated with a viral infection.
*Persistance of  Various viral agents,such as [[coxsackie B]], [[adenovirus]], and [[cytomegalovirus]] ,suggesting [[Autoimmune regulator|autoimmune response]] associated with a [[viral infection]].
*It is thought that postpericardiotomy syndrome is mediated by development of antibodies againts heart.
*It is thought that [[P-ATPase|postpericardiotomy syndrome]] is mediated by development of [[antibodies]] againts heart.
*The progression to postpericardiotomy syndrome  usually secondary to cell-mediated immunity.<ref name="pmid19069464">{{cite journal| author=Andreev DA, Giliarov MIu, Syrkin AL, Udovichenko AE, Gerok DV| title=[Postcardiotomy syndrome outside a cardiosurgical clinic]. | journal=Klin Med (Mosk) | year= 2008 | volume= 86 | issue= 10 | pages= 67-71 | pmid=19069464 | doi= | pmc= | url= }} </ref><ref name="pmid8379795">{{cite journal| author=Hazelrigg SR, Mack MJ, Landreneau RJ, Acuff TE, Seifert PE, Auer JE| title=Thoracoscopic pericardiectomy for effusive pericardial disease. | journal=Ann Thorac Surg | year= 1993 | volume= 56 | issue= 3 | pages= 792-5 | pmid=8379795 | doi= | pmc= | url= }} </ref><ref name="pmid11345387">{{cite journal| author=Mott AR, Fraser CD, Kusnoor AV, Giesecke NM, Reul GJ, Drescher KL et al.| title=The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass. | journal=J Am Coll Cardiol | year= 2001 | volume= 37 | issue= 6 | pages= 1700-6 | pmid=11345387 | doi=10.1016/s0735-1097(01)01223-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11345387  }} </ref>
*The progression to [[P-type ATPase|postpericardiotomy syndrome]] usually secondary to [[cell-mediated immunity]].<ref name="pmid19069464">{{cite journal| author=Andreev DA, Giliarov MIu, Syrkin AL, Udovichenko AE, Gerok DV| title=[Postcardiotomy syndrome outside a cardiosurgical clinic]. | journal=Klin Med (Mosk) | year= 2008 | volume= 86 | issue= 10 | pages= 67-71 | pmid=19069464 | doi= | pmc= | url= }} </ref><ref name="pmid8379795">{{cite journal| author=Hazelrigg SR, Mack MJ, Landreneau RJ, Acuff TE, Seifert PE, Auer JE| title=Thoracoscopic pericardiectomy for effusive pericardial disease. | journal=Ann Thorac Surg | year= 1993 | volume= 56 | issue= 3 | pages= 792-5 | pmid=8379795 | doi= | pmc= | url= }} </ref><ref name="pmid11345387">{{cite journal| author=Mott AR, Fraser CD, Kusnoor AV, Giesecke NM, Reul GJ, Drescher KL et al.| title=The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass. | journal=J Am Coll Cardiol | year= 2001 | volume= 37 | issue= 6 | pages= 1700-6 | pmid=11345387 | doi=10.1016/s0735-1097(01)01223-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11345387  }} </ref>


==Causes==
==Causes==
*Pericardial and/or pleural bleeding
The most important causes of the postpericardiotomy syndrome:
*[[Pericardial Disease|Pericardial]] and/or [[Pleural cavity|pleural]] bleeding
*[[Heart surgery]]
*[[Heart surgery]]
*Postpericardiotomy syndrome can be an unusual complication after [[percutaneous coronary intervention]] such as stent implantation or after implantation of epicardial pacemaker leads and transvenous pacemaker leads, following blunt trauma, stab wounds, and heart puncture. <ref>Gungor B, Ucer E, Erdinler IC. Uncommon presentation of postcardiac injury syndrome: Acute pericarditis after percutaneous coronary intervention. ''Int J Cardiol''. Aug 14 2007</ref> <ref>Peters RW, Scheinman MM, Raskin S, Thomas AN. Unusual complications of epicardial pacemakers. Recurrent pericarditis, cardiac tamponade and pericardial constriction. ''Am J Cardiol''. May 1980;45(5):1088-94.</ref> <ref>Vinit J, Sagnol P, Buttard P, Laurent G, Wolf JE, Dellinger A. Recurrent delayed pericarditis after pacemaker implantation: a post-pericardiotomy-like syndrome?. ''Rev Med Interne''. Feb 2007;28(2):137-40.</ref> <ref>Zeltser I, Rhodes LA, Tanel RE, Vetter VL, Gaynor JW, Spray TL. Postpericardiotomy syndrome after permanent pacemaker implantation in children and young adults. ''Ann Thorac Surg''. Nov 2004;78(5):1684-7.</ref> <ref>Sasaki A, Kobayashi H, Okubo T, Namatame Y, Yamashina A. Repeated postpericardiotomy syndrome following a temporary transvenous pacemaker insertion, a permanent transvenous pacemaker insertion and surgical pericardiotomy. ''Jpn Circ J''. Apr 2001;65(4):343-4.</ref> <ref>Goutal H, Baur F, Bonnevie L, Monnier G, Le Blainvaux M, Brion R. Postpericardiotomy syndrome; a rare complication of transcavitary cardiac pacing: apropos of a case. ''Arch Mal Coeur Vaiss''. Dec 1995;88(12):1901-3.</ref> <ref>Hargreaves M, Bashir Y. Postcardiotomy syndrome following transvenous pacemaker insertion. ''Eur Heart J''. Jul 1994;15(7):1005-7.</ref> <ref>Goodkind MJ, Bloomer WE, Goodyer AV. Recurrent pericardial effusion after nonpenetrating chest trauma: report of two cases treated with adrenocortical steroids. ''N Engl J Med''. Nov 3 1960;263:874-81.</ref> <ref>Tabatznik B, Isaacs JP. Postpericardiotomy syndrome following traumatic hemopericardium. ''Am J Cardiol''. Jan 1961;7:83-96.</ref> <ref>Peter RH, Whalen RE, Orgain ES, McIntosh HD. Postpericardiotomy syndrome as a complication of percutaneous left ventricular puncture. ''Am J Cardiol''. Jan 1966;17(1):86-90.</ref>
*[[Concussion|Postpericardiotomy syndrome]] can be an unusual complication after [[percutaneous coronary intervention]] such as stent implantation or after implantation of [[Epicardial fat pad|epicardial]] pacemaker leads and transvenous pacemaker leads, following blunt trauma, stab wounds, and heart puncture.<ref>Gungor B, Ucer E, Erdinler IC. Uncommon presentation of postcardiac injury syndrome: Acute pericarditis after percutaneous coronary intervention. ''Int J Cardiol''. Aug 14 2007</ref><ref>Peters RW, Scheinman MM, Raskin S, Thomas AN. Unusual complications of epicardial pacemakers. Recurrent pericarditis, cardiac tamponade and pericardial constriction. ''Am J Cardiol''. May 1980;45(5):1088-94.</ref><ref>Vinit J, Sagnol P, Buttard P, Laurent G, Wolf JE, Dellinger A. Recurrent delayed pericarditis after pacemaker implantation: a post-pericardiotomy-like syndrome?. ''Rev Med Interne''. Feb 2007;28(2):137-40.</ref><ref>Zeltser I, Rhodes LA, Tanel RE, Vetter VL, Gaynor JW, Spray TL. Postpericardiotomy syndrome after permanent pacemaker implantation in children and young adults. ''Ann Thorac Surg''. Nov 2004;78(5):1684-7.</ref><ref>Sasaki A, Kobayashi H, Okubo T, Namatame Y, Yamashina A. Repeated postpericardiotomy syndrome following a temporary transvenous pacemaker insertion, a permanent transvenous pacemaker insertion and surgical pericardiotomy. ''Jpn Circ J''. Apr 2001;65(4):343-4.</ref><ref>Goutal H, Baur F, Bonnevie L, Monnier G, Le Blainvaux M, Brion R. Postpericardiotomy syndrome; a rare complication of transcavitary cardiac pacing: apropos of a case. ''Arch Mal Coeur Vaiss''. Dec 1995;88(12):1901-3.</ref><ref>Hargreaves M, Bashir Y. Postcardiotomy syndrome following transvenous pacemaker insertion. ''Eur Heart J''. Jul 1994;15(7):1005-7.</ref><ref>Goodkind MJ, Bloomer WE, Goodyer AV. Recurrent pericardial effusion after nonpenetrating chest trauma: report of two cases treated with adrenocortical steroids. ''N Engl J Med''. Nov 3 1960;263:874-81.</ref><ref>Tabatznik B, Isaacs JP. Postpericardiotomy syndrome following traumatic hemopericardium. ''Am J Cardiol''. Jan 1961;7:83-96.</ref><ref>Peter RH, Whalen RE, Orgain ES, McIntosh HD. Postpericardiotomy syndrome as a complication of percutaneous left ventricular puncture. ''Am J Cardiol''. Jan 1966;17(1):86-90.</ref>


==Differentiating Postpericardiotomy Syndrome from other Conditions==
==Differentiating Postpericardiotomy Syndrome from other Conditions==
Postpericardiotomy syndrome should be distinguished from [[Dressler's syndrome]] which is an autoimmune process that occurs 2-10 weeks following [[ST elevation MI]] <ref>{{cite journal | author = Krainin F, Flessas A, Spodick D | title = Infarction-associated pericarditis. Rarity of diagnostic electrocardiogram. | journal = N Engl J Med | volume = 311 | issue = 19 | pages = 1211-4 | year = 1984 | id = PMID 6493274}}</ref>.  It should also be differentiated from the much more common post myocardial infarction pericarditis that occurs between days 2 and 4 after myocardial infarction. Postpericardiotomy syndrome should also be differentiated from [[pulmonary embolism]], another cause of [[pleuritic]] [[chest pain]] in people who have been hospitalized and/or undergone surgical procedures within the preceding weeks.


[[Postnatal depression|Postpericardiotomy syndrom]]<nowiki/>e should be distinguished from [[Dressler's syndrome]] which is an [[Autoimmunity|autoimmune]] process that occurs 2-10 weeks following [[ST elevation MI]].<ref>{{cite journal | author = Krainin F, Flessas A, Spodick D | title = Infarction-associated pericarditis. Rarity of diagnostic electrocardiogram. | journal = N Engl J Med | volume = 311 | issue = 19 | pages = 1211-4 | year = 1984 | id = PMID 6493274}}</ref> It should also be differentiated from the much more common post myocardial infarction pericarditis that occurs between days 2 and 4 after [[myocardial infarction]]. [[Fatigue|Postpericardiotomy]] syndrome should also be differentiated from [[pulmonary embolism]], another cause of [[pleuritic]] [[chest pain]] in people who have been hospitalized and/or undergone surgical procedures within the preceding weeks.
==Epidemiology and Demographics==
==Epidemiology and Demographics==
It is estimated that anywhere from 2% to 30% of patients who undergo [[heart surgery]] who have had their [[pericardium]] opened will develop postpericardiotomy syndrome.
It is estimated that anywhere from 2000-30,000 out of 100,000 of patients who undergo [[heart surgery]] who have had their [[pericardium]] opened will develop [[Post-Concussion Syndrome|postpericardiotomy syndrome.]]


===Age===
===Age===
The risk of postpericardiotomy syndrome increases with age.
The risk of [[Postperfusion syndrome|postpericardiotomy syndrome]] increases with age.
*Infants: Uncommon
*Infants: Uncommon
*Children: Not uncommon
*Children: Not uncommon
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==Risk Factors==
==Risk Factors==
*Postpericardiotomy syndrome occurs more frequently in patients who have undergone [[heart surgery]] that involves opening the [[pericardium]].
*[[Post-Concussion Syndrome|Postpericardiotomy syndrome]] occurs more frequently in patients who have undergone [[heart surgery]] that involves opening the [[pericardium]].
*Many studies has been shown higher  incidence of pps after AVR,MVR,and Aortic surgery.
*Many studies has been shown higher  incidence of [[P-ATPase|pps]] after [[AVR]], [[MVR]], and [[Aortic sclerosis causes|aortic surgery]].


==Natural History, Complications, Prognosis==
==Natural History, Complications, Prognosis==
===Natural History===
===Natural History===
The onset of symptoms is 1 to 6 weeks after [[cardiac surgery]]. In general the disease is self-limited and the symptoms and signs are mild and resolve in 2 to 3 weeks.
The onset of [[symptoms]] is 1 to 6 weeks after [[cardiac surgery]]. In general the disease is self-limited and the [[Symptom|symptoms]] and [[Symptom|signs]] are mild and resolve in 2 to 3 weeks.


===Complications===
===Complications===
*[[Pericardial effusion]] may result from the accumulation of fluids as a result of inflammation in the pericardial sac.
*[[Pericardial effusion]] may result from the accumulation of fluids as a result of inflammation in the [[pericardial sac]].
*[[Cardiac tamponade]] can occur if the accumulation of fluids in the pericardium is large enough and rapid enough. This occurs in <1% of patients.
*[[Cardiac tamponade]] can occur if the accumulation of fluids in the [[pericardium]] is large enough and rapid enough. This occurs in <1% of patients.
*[[Constrictive pericarditis]] can occur if there is a chronic inflammatory response
*[[Constrictive pericarditis]] can occur if there is a chronic inflammatory response.


===Prognosis===
===Prognosis===
In general the prognosis is good.
Prognosis is generally good.<ref name="pmid23040075">{{cite journal| author=Imazio M, Hoit BD| title=Post-cardiac injury syndromes. An emerging cause of pericardial diseases. | journal=Int J Cardiol | year= 2013 | volume= 168 | issue= 2 | pages= 648-52 | pmid=23040075 | doi=10.1016/j.ijcard.2012.09.052 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23040075  }} </ref>


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of postpericardiotomy syndrome is made when at least two of the following five  diagnostic criteria are met: New or worsening pleural effusion,New or worsening pericardial effusion,fever,pleural chestpain,pleural or pericardial rubbing.<ref name="pmid28425090">{{cite journal| author=van Osch D, Nathoe HM, Jacob KA, Doevendans PA, van Dijk D, Suyker WJ et al.| title=Determinants of the postpericardiotomy syndrome: a systematic review. | journal=Eur J Clin Invest | year= 2017 | volume= 47 | issue= 6 | pages= 456-467 | pmid=28425090 | doi=10.1111/eci.12764 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28425090  }} </ref>
The diagnosis of [[Nonvalvular cardiovascular device-related infections|postpericardiotomy syndrome]] is made when at least two of the following five  [[diagnostic criteria]] are met: New or worsening [[pleural effusion]], new or worsening [[pericardial effusion]], fever, [[Pleurae|pleural chestpain]], [[Pleural cavity|pleural or pericardial rubbing]].<ref name="pmid28425090">{{cite journal| author=van Osch D, Nathoe HM, Jacob KA, Doevendans PA, van Dijk D, Suyker WJ et al.| title=Determinants of the postpericardiotomy syndrome: a systematic review. | journal=Eur J Clin Invest | year= 2017 | volume= 47 | issue= 6 | pages= 456-467 | pmid=28425090 | doi=10.1111/eci.12764 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28425090  }} </ref>


===History and Symptoms===
===History and Symptoms===
Common symptoms of postpericardiotomy syn include fever,chstpain,dyspenea.Less symptoms of postpericardiotomy syn are malaise,decrease appetite,arthralgia.<ref name="pmid28425090">{{cite journal| author=van Osch D, Nathoe HM, Jacob KA, Doevendans PA, van Dijk D, Suyker WJ et al.| title=Determinants of the postpericardiotomy syndrome: a systematic review. | journal=Eur J Clin Invest | year= 2017 | volume= 47 | issue= 6 | pages= 456-467 | pmid=28425090 | doi=10.1111/eci.12764 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28425090  }} </ref>
Common symptoms of [[Postperfusion syndrome|postpericardiotomy syndrome]] include fever, [[Celiac disease|chest pain, dyspenea]]. Less symptoms of [[Postperfusion syndrome|postpericardiotomy syndrome]] are [[malaise]], decrease appetite, [[Arthralgias|arthralgia]].<ref name="pmid28425090">{{cite journal| author=van Osch D, Nathoe HM, Jacob KA, Doevendans PA, van Dijk D, Suyker WJ et al.| title=Determinants of the postpericardiotomy syndrome: a systematic review. | journal=Eur J Clin Invest | year= 2017 | volume= 47 | issue= 6 | pages= 456-467 | pmid=28425090 | doi=10.1111/eci.12764 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28425090  }} </ref>


===Physical Examination===
===Physical Examination===
====Vital signs====
====Vital signs====
[[Tachycardia]] may be present
[[Tachycardia]] may be present [[hypoxemia]] may be present.
[[Hypoxemia]] may be present


====Cardiac====
====Cardiac====
[[Pericardial friction rub]] is often present, an [[enlarged heart]] may be present
[[Pericardial friction rub]] is often present, an [[enlarged heart]] may be present.


====Lungs====
====Lungs====
Signs of a [[pleural effusion]] may be present
Signs of a [[pleural effusion]] may be present.


====Abdominal Exam====
====Abdominal Exam====
[[Hepatomegaly]] may be present
[[Hepatomegaly]] may be present.


====Extremities====
====Extremities====
[[Pedal edema]] may be present if [[pericardial constriction]] or a [[pericardial effusion]] is present
[[Pedal edema]] may be present if [[pericardial constriction]] or a [[pericardial effusion]] is present.


===Laboratory Findings===
===Laboratory Findings===
* [[CBC]] will be elevated with a [[leukocytosis]] and a leftward shift
* [[CBC]] will be elevated with a [[leukocytosis]] and a leftward shift.
* [[ESR]] will be elevated
* [[ESR]] will be elevated.
* [[CRP]] will be elevated
* [[CRP]] will be elevated.
* Given the presence of fever and the post-operative status of the patient, [[blood cultures]] should be obtained to rule out [[endocarditis]].
* Given the presence of fever and the post-operative status of the patient, [[blood cultures]] should be obtained to rule out [[endocarditis]].
* [[Antiheart antibodies]] are elevated
* [[Antiheart antibodies]] are elevated.
* [[Cardiac biomarker]] testing is usually not helpful as it has not been shown to differ between those patients with and those without postpericardiotomy syndrome.
* [[Cardiac biomarker]] testing is usually not helpful as it has not been shown to differ between those patients with and those without [[Postperfusion syndrome|postpericardiotomy syndrome]].
* Send pericardial fluid for CBC and differential, culture and sensitivity, gram stain, protein and triglyceride level (to rule out [[chylopericardium]]
* Send pericardial fluid for [[Complete blood count|CBC]] and differential, [[Celiac disease|culture and sensitivity, gram stain]], protein and [[triglyceride]] level (to rule out [[chylopericardium]]).
===Electrocardiogram===
An [[ECGF1|ECG]] may be helpful in the diagnosis of [[Posaconazole (patient information)|postpericardiotomy syndrome.]] Findings on an [[ECG]] diagnostic of [[Pericarditis (patient information)|pericarditis]] include [[ST-segment depression|ST-segment elevation and T-wave inversion and PR depression]] in multiple leads.<ref name="pmid22897372">{{cite journal| author=Bucekova E, Simkova I, Hulman M| title=Postpericardiotomy syndrome - post-cardiac injury syndrome. | journal=Bratisl Lek Listy | year= 2012 | volume= 113 | issue= 8 | pages= 481-5 | pmid=22897372 | doi=10.4149/bll_2012_106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22897372  }} </ref>


===Chest X Ray===
===Chest X Ray===
*Often a [[pleural effusion]] is present with blunting of the costophrenic angles.
*Often a [[pleural effusion]] is present with blunting of the [[Costophrenic angle|costophrenic angles]].
*[[Cardiomegaly]] may be present if there is a sufficient [[pericardial effusion]]
*[[Cardiomegaly]] may be present if there is a sufficient [[pericardial effusion]].
===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
Echocardiography  may be helpful in the diagnosis of pericardial infussion.<ref name="pmid27761786">{{cite journal| author=Tamarappoo BK, Klein AL| title=Post-pericardiotomy Syndrome. | journal=Curr Cardiol Rep | year= 2016 | volume= 18 | issue= 11 | pages= 116 | pmid=27761786 | doi=10.1007/s11886-016-0791-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27761786  }} </ref> Finding on an echocardiography of postpericardiotomy syn include pericardial effusion.<ref name="pmid30927107">{{cite journal| author=Ünal E, Karcaaltincaba M, Akpinar E, Ariyurek OM| title=The imaging appearances of various pericardial disorders. | journal=Insights Imaging | year= 2019 | volume= 10 | issue= 1 | pages= 42 | pmid=30927107 | doi=10.1186/s13244-019-0728-4 | pmc=6441059 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30927107  }} </ref>
*[[Echocardiography and ultrasound|Echocardiography]] may be helpful in the diagnosis of [[Postperfusion syndrome|postpericardiotomy syndrome]].<ref name="pmid27761786">{{cite journal| author=Tamarappoo BK, Klein AL| title=Post-pericardiotomy Syndrome. | journal=Curr Cardiol Rep | year= 2016 | volume= 18 | issue= 11 | pages= 116 | pmid=27761786 | doi=10.1007/s11886-016-0791-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27761786  }} </ref>
*Finding on an [[Echocardiography and ultrasound|echocardiography]] of [[Postperfusion syndrome|postpericardiotomy syn]] include [[pericardial effusion]].<ref name="pmid30927107">{{cite journal| author=Ünal E, Karcaaltincaba M, Akpinar E, Ariyurek OM| title=The imaging appearances of various pericardial disorders. | journal=Insights Imaging | year= 2019 | volume= 10 | issue= 1 | pages= 42 | pmid=30927107 | doi=10.1186/s13244-019-0728-4 | pmc=6441059 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30927107  }} </ref>


===CT scan==
===CT scan===


Cardiac CT scan may be helpful in the diagnosis of pericardial effusion. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[Cardiac|Cardiac CT scan]] may be helpful in the diagnosis of [[Pericardial effusion (patient information)|pericardial effusion]].
*Findings on [[Computed tomography|CT scan]] suggestive of [[Postperfusion syndrome|postpericardiotomy syndrome]] include [[pericardial effusion]] and findings on [[CT scan]] diagnostic of [[Pericardial effusion (patient information)|pericardial effusion]] include [[Pericardial|pericardial thickening]].<ref name="pmid28100899">{{cite journal| author=Çetin MS, Özcan Çetin EH, Özdemir M, Topaloğlu S, Aras D, Temizhan A et al.| title=Effectiveness of computed tomography attenuation values in characterization of pericardial effusion. | journal=Anatol J Cardiol | year= 2017 | volume= 17 | issue= 4 | pages= 322-327 | pmid=28100899 | doi=10.14744/AnatolJCardiol.2016.7353 | pmc=5469113 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28100899  }} </ref>


===MRI===
===MRI===
 
[[Cardiac MRI]] may be helpful in the diagnosis of [[Postperfusion syndrome|postpericardiotomy syn]]. Findings on [[MRI scan|MRI]] suggestive of [[pericardial effusion]] is [[Pericardiacophrenic veins|pericardial thickening]].<ref name="pmid27761786">{{cite journal| author=Tamarappoo BK, Klein AL| title=Post-pericardiotomy Syndrome. | journal=Curr Cardiol Rep | year= 2016 | volume= 18 | issue= 11 | pages= 116 | pmid=27761786 | doi=10.1007/s11886-016-0791-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27761786  }} </ref>
*Cardiac MRI may be helpful in the diagnosis of postpericardiotomy syn. Findings on MRI suggestive of pericardial effusion is pericardial thickening.<ref name="pmid27761786">{{cite journal| author=Tamarappoo BK, Klein AL| title=Post-pericardiotomy Syndrome. | journal=Curr Cardiol Rep | year= 2016 | volume= 18 | issue= 11 | pages= 116 | pmid=27761786 | doi=10.1007/s11886-016-0791-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27761786  }} </ref>


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
There are no other imaging findings associated with [[Postperfusion syndrome|postpericardiotomy syndrome]].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
There are no other diagnostic studies associated with [[Postperfusion syndrome|postpericardiotomy syndrome]].


OR
==Treatment==
===Medical Therapy===


[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*The mainstay of treatment for is [[Nonsteroidal antiinflammatory agent|nonsteroidal anti inflammatory drugs]],such as [[Aspirin]] and [[Ibuprofen]].


OR
*[[Pharmacological|Pharmacologic medical therapies]] for [[Postperfusion syndrome|postpericardiotomy sydrome]] include [[NSAIDS|NSAIDs, colchicine and golococorticoid]].<ref name="pmid26320112">{{cite journal| author=Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J et al.| title=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)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). | journal=Eur Heart J | year= 2015 | volume= 36 | issue= 42 | pages= 2921-2964 | pmid=26320112 | doi=10.1093/eurheartj/ehv318 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26320112  }} </ref>


Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
===Surgery===
* [[S-(+)-methamphetamine|Surgical intervention]] is not recommended for the management of [[Pocket Dialing|postpericardiotomy syndrome.]]
* In 2016, there was a case report  who was treated by [[I-SMAD|IPC(indwelling pleural catheter)]] because of recurrent [[Ca|pleural effusion]] due to [[Calcium-aluminium-rich inclusion|pps]].<ref name="pmid26905442">{{cite journal| author=Bujarski S, Guy E| title=Use of Indwelling Pleural Catheter for Recurrent Pleural Effusion Due to Postpericardiotomy Syndrome: A Case Report. | journal=J Bronchology Interv Pulmonol | year= 2016 | volume= 23 | issue= 2 | pages= 160-2 | pmid=26905442 | doi=10.1097/LBR.0000000000000196 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26905442  }} </ref>


==Treatment==
===Primary Prevention===
Postpericardiotomy syndrome is typically treated similar to Dressler's syndrome with high dose (up to 650 mg PO q 4 to 6 hours) enteric-coated [[aspirin]].  [[Acetominophen]] can be added for pain management as this does not affect the coagulation system.  Anticoagulants should be discontinued if the patient develops a pericardial effusion.  
* Effective measures for the primary prevention of [[Postperfusion syndrome|postpericardiotomy syndrome]] is prophylactic administration of [[Colchicine toxicity|colchicine]].<ref name="pmid20805112">{{cite journal| author=Imazio M, Trinchero R, Brucato A, Rovere ME, Gandino A, Cemin R et al.| title=COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. | journal=Eur Heart J | year= 2010 | volume= 31 | issue= 22 | pages= 2749-54 | pmid=20805112 | doi=10.1093/eurheartj/ehq319 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20805112  }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21320925 Review in: Ann Intern Med. 2011 Feb 15;154(4):JC2-10] </ref>
* [[Colchicine]] will be given to patients pre or post cardiac surgery.<ref name="pmid20805112">{{cite journal| author=Imazio M, Trinchero R, Brucato A, Rovere ME, Gandino A, Cemin R et al.| title=COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. | journal=Eur Heart J | year= 2010 | volume= 31 | issue= 22 | pages= 2749-54 | pmid=20805112 | doi=10.1093/eurheartj/ehq319 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20805112  }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21320925 Review in: Ann Intern Med. 2011 Feb 15;154(4):JC2-10] </ref>


[[Non-steroidal_anti-inflammatory_drug|NSAIDs]] such as [[ibuprofen]] should be avoided in the peri-infarct period as they:
===Secondary Prevention===
#Increase the risk of [[reinfarction]]  
There are no established measures for the secondary prevention of [[Post-Cancer Fatigue|postpericardiotomy syndrome]].
#Adversely impact left ventricular remodeling.
#Block the effectiveness of [[aspirin]]
#May cause increased [[bleeding]]


===ACC/AHA Treatment Guidelines (DO NOT EDIT)<ref name="pmid15339869">{{cite journal |author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK |title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) |journal=Circulation |volume=110 |issue=9 |pages=e82–292 |year=2004 |month=August |pmid=15339869 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>===
===ACC/AHA Treatment Guidelines (DO NOT EDIT)<ref name="pmid15339869">{{cite journal |author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK |title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) |journal=Circulation |volume=110 |issue=9 |pages=e82–292 |year=2004 |month=August |pmid=15339869 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>===
Line 157: Line 157:


==Sources==
==Sources==
*The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction <ref name="pmid15339869">{{cite journal |author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK |title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) |journal=Circulation |volume=110 |issue=9 |pages=e82–292 |year=2004 |month=August |pmid=15339869 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>
* The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction <ref name="pmid15339869">{{cite journal |author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK |title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) |journal=Circulation |volume=110 |issue=9 |pages=e82–292 |year=2004 |month=August |pmid=15339869 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>


*The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>
* The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>


==References==
==References==

Latest revision as of 00:11, 19 February 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD[2]

Synonyms and keywords:Postcommissurotomy syndrome; PCS; PPS; Dressler syn; Post cardiac injury syndrome; Post heart injury syndrome; Post pericardial injury syndrome

Overview

The postpericardiotomy syndrome is inflammation of the pericardium following cardiac surgery. Symptoms can occur from days to weeks after the operation. The syndrome is thought to have an autoimmune basis. Postcardiac injury was first discovered by soloff, in 1953. Later Itoh in 1958 ,was first discovered same syndrome and labelled it postpericardiotomy syndrome. In 1956, Dressler described PMIS, and therefore referred to as Dressler syndrome. It has been postulated that the syndrome is an autoimmune response to pericardial and/or pleural bleeding or surgical trauma. Persistance of Various viral agents,such as coxsackie B, adenovirus, and cytomegalovirus ,suggesting autoimmune response associated with a viral infection. It is thought that postpericardiotomy syndrome is mediated by development of antibodies againts heart. The progression to postpericardiotomy syndrome usually secondary to cell-mediated immunity.

Historical Perspective

Classification

There is no established system for the classification of postpericardiotomy syndrome.

Pathophysiology

Causes

The most important causes of the postpericardiotomy syndrome:

Differentiating Postpericardiotomy Syndrome from other Conditions

Postpericardiotomy syndrome should be distinguished from Dressler's syndrome which is an autoimmune process that occurs 2-10 weeks following ST elevation MI.[14] It should also be differentiated from the much more common post myocardial infarction pericarditis that occurs between days 2 and 4 after myocardial infarction. Postpericardiotomy syndrome should also be differentiated from pulmonary embolism, another cause of pleuritic chest pain in people who have been hospitalized and/or undergone surgical procedures within the preceding weeks.

Epidemiology and Demographics

It is estimated that anywhere from 2000-30,000 out of 100,000 of patients who undergo heart surgery who have had their pericardium opened will develop postpericardiotomy syndrome.

Age

The risk of postpericardiotomy syndrome increases with age.

  • Infants: Uncommon
  • Children: Not uncommon
  • Adults: Common, occurs in 30% of patients following surgery in which the pericardium is opened

Risk Factors

Natural History, Complications, Prognosis

Natural History

The onset of symptoms is 1 to 6 weeks after cardiac surgery. In general the disease is self-limited and the symptoms and signs are mild and resolve in 2 to 3 weeks.

Complications

Prognosis

Prognosis is generally good.[15]

Diagnosis

Diagnostic Study of Choice

The diagnosis of postpericardiotomy syndrome is made when at least two of the following five diagnostic criteria are met: New or worsening pleural effusion, new or worsening pericardial effusion, fever, pleural chestpain, pleural or pericardial rubbing.[16]

History and Symptoms

Common symptoms of postpericardiotomy syndrome include fever, chest pain, dyspenea. Less symptoms of postpericardiotomy syndrome are malaise, decrease appetite, arthralgia.[16]

Physical Examination

Vital signs

Tachycardia may be present hypoxemia may be present.

Cardiac

Pericardial friction rub is often present, an enlarged heart may be present.

Lungs

Signs of a pleural effusion may be present.

Abdominal Exam

Hepatomegaly may be present.

Extremities

Pedal edema may be present if pericardial constriction or a pericardial effusion is present.

Laboratory Findings

Electrocardiogram

An ECG may be helpful in the diagnosis of postpericardiotomy syndrome. Findings on an ECG diagnostic of pericarditis include ST-segment elevation and T-wave inversion and PR depression in multiple leads.[17]

Chest X Ray

Echocardiography or Ultrasound

CT scan

MRI

Cardiac MRI may be helpful in the diagnosis of postpericardiotomy syn. Findings on MRI suggestive of pericardial effusion is pericardial thickening.[18]

Other Imaging Findings

There are no other imaging findings associated with postpericardiotomy syndrome.

Other Diagnostic Studies

There are no other diagnostic studies associated with postpericardiotomy syndrome.

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

There are no established measures for the secondary prevention of postpericardiotomy syndrome.

ACC/AHA Treatment Guidelines (DO NOT EDIT)[24]

“

Class I

1. Aspirin is recommended for treatment of pericarditis after STEMI. Doses as high as 650 mg orally (entericcoated) every 4 to 6 hours may be needed. (Level of Evidence: B)

2. Anticoagulation should be immediately discontinued if pericardial effusion develops or increases. (Level of Evidence: C)

Class IIa

1. For episodes of pericarditis after STEMI that are not adequately controlled with aspirin, it is reasonable to administer 1 or more of the following:

a. Colchicine 0.6 mg orally every 12 hours (Level of Evidence: B)
b. Acetaminophen 500 mg orally every 6 hours. (Level of Evidence: C)

Class IIb

1. Corticosteroids might be considered only as a last resort in patients with pericarditis refractory to aspirin or NSAIDs. Although corticosteroids are effective for pain relief, their use is associated with an increased risk of scar thinning and myocardial rupture. (Level of Evidence: C)

2. Nonsteroidal anti-inflammatory drugs may be considered for pain relief; however, they should not be used for extended periods because of their effect on platelet function, an increased risk of myocardial scar thinning, and infarct expansion. (Level of Evidence: B)

Class III

1. Ibuprofen should not be used for pain relief because it blocks the antiplatelet effect of aspirin and it can cause myocardial scar thinning and infarct expansion. (Level of Evidence: B)

”

Sources

  • The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [24]
  • The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [25]

References

  1. ↑ Andreev DA, Giliarov MIu, Syrkin AL, Udovichenko AE, Gerok DV (2008). "[Postcardiotomy syndrome outside a cardiosurgical clinic]". Klin Med (Mosk). 86 (10): 67–71. PMID 19069464.
  2. ↑ Hazelrigg SR, Mack MJ, Landreneau RJ, Acuff TE, Seifert PE, Auer JE (1993). "Thoracoscopic pericardiectomy for effusive pericardial disease". Ann Thorac Surg. 56 (3): 792–5. PMID 8379795.
  3. ↑ Mott AR, Fraser CD, Kusnoor AV, Giesecke NM, Reul GJ, Drescher KL; et al. (2001). "The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass". J Am Coll Cardiol. 37 (6): 1700–6. doi:10.1016/s0735-1097(01)01223-2. PMID 11345387.
  4. ↑ Gungor B, Ucer E, Erdinler IC. Uncommon presentation of postcardiac injury syndrome: Acute pericarditis after percutaneous coronary intervention. Int J Cardiol. Aug 14 2007
  5. ↑ Peters RW, Scheinman MM, Raskin S, Thomas AN. Unusual complications of epicardial pacemakers. Recurrent pericarditis, cardiac tamponade and pericardial constriction. Am J Cardiol. May 1980;45(5):1088-94.
  6. ↑ Vinit J, Sagnol P, Buttard P, Laurent G, Wolf JE, Dellinger A. Recurrent delayed pericarditis after pacemaker implantation: a post-pericardiotomy-like syndrome?. Rev Med Interne. Feb 2007;28(2):137-40.
  7. ↑ Zeltser I, Rhodes LA, Tanel RE, Vetter VL, Gaynor JW, Spray TL. Postpericardiotomy syndrome after permanent pacemaker implantation in children and young adults. Ann Thorac Surg. Nov 2004;78(5):1684-7.
  8. ↑ Sasaki A, Kobayashi H, Okubo T, Namatame Y, Yamashina A. Repeated postpericardiotomy syndrome following a temporary transvenous pacemaker insertion, a permanent transvenous pacemaker insertion and surgical pericardiotomy. Jpn Circ J. Apr 2001;65(4):343-4.
  9. ↑ Goutal H, Baur F, Bonnevie L, Monnier G, Le Blainvaux M, Brion R. Postpericardiotomy syndrome; a rare complication of transcavitary cardiac pacing: apropos of a case. Arch Mal Coeur Vaiss. Dec 1995;88(12):1901-3.
  10. ↑ Hargreaves M, Bashir Y. Postcardiotomy syndrome following transvenous pacemaker insertion. Eur Heart J. Jul 1994;15(7):1005-7.
  11. ↑ Goodkind MJ, Bloomer WE, Goodyer AV. Recurrent pericardial effusion after nonpenetrating chest trauma: report of two cases treated with adrenocortical steroids. N Engl J Med. Nov 3 1960;263:874-81.
  12. ↑ Tabatznik B, Isaacs JP. Postpericardiotomy syndrome following traumatic hemopericardium. Am J Cardiol. Jan 1961;7:83-96.
  13. ↑ Peter RH, Whalen RE, Orgain ES, McIntosh HD. Postpericardiotomy syndrome as a complication of percutaneous left ventricular puncture. Am J Cardiol. Jan 1966;17(1):86-90.
  14. ↑ Krainin F, Flessas A, Spodick D (1984). "Infarction-associated pericarditis. Rarity of diagnostic electrocardiogram". N Engl J Med. 311 (19): 1211–4. PMID 6493274.
  15. ↑ Imazio M, Hoit BD (2013). "Post-cardiac injury syndromes. An emerging cause of pericardial diseases". Int J Cardiol. 168 (2): 648–52. doi:10.1016/j.ijcard.2012.09.052. PMID 23040075.
  16. ↑ 16.0 16.1 van Osch D, Nathoe HM, Jacob KA, Doevendans PA, van Dijk D, Suyker WJ; et al. (2017). "Determinants of the postpericardiotomy syndrome: a systematic review". Eur J Clin Invest. 47 (6): 456–467. doi:10.1111/eci.12764. PMID 28425090.
  17. ↑ Bucekova E, Simkova I, Hulman M (2012). "Postpericardiotomy syndrome - post-cardiac injury syndrome". Bratisl Lek Listy. 113 (8): 481–5. doi:10.4149/bll_2012_106. PMID 22897372.
  18. ↑ 18.0 18.1 Tamarappoo BK, Klein AL (2016). "Post-pericardiotomy Syndrome". Curr Cardiol Rep. 18 (11): 116. doi:10.1007/s11886-016-0791-0. PMID 27761786.
  19. ↑ Ünal E, Karcaaltincaba M, Akpinar E, Ariyurek OM (2019). "The imaging appearances of various pericardial disorders". Insights Imaging. 10 (1): 42. doi:10.1186/s13244-019-0728-4. PMC 6441059. PMID 30927107.
  20. ↑ Çetin MS, Özcan Çetin EH, Özdemir M, Topaloğlu S, Aras D, Temizhan A; et al. (2017). "Effectiveness of computed tomography attenuation values in characterization of pericardial effusion". Anatol J Cardiol. 17 (4): 322–327. doi:10.14744/AnatolJCardiol.2016.7353. PMC 5469113. PMID 28100899.
  21. ↑ Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J; et al. (2015). "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)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)". Eur Heart J. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. PMID 26320112.
  22. ↑ Bujarski S, Guy E (2016). "Use of Indwelling Pleural Catheter for Recurrent Pleural Effusion Due to Postpericardiotomy Syndrome: A Case Report". J Bronchology Interv Pulmonol. 23 (2): 160–2. doi:10.1097/LBR.0000000000000196. PMID 26905442.
  23. ↑ 23.0 23.1 Imazio M, Trinchero R, Brucato A, Rovere ME, Gandino A, Cemin R; et al. (2010). "COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial". Eur Heart J. 31 (22): 2749–54. doi:10.1093/eurheartj/ehq319. PMID 20805112. Review in: Ann Intern Med. 2011 Feb 15;154(4):JC2-10
  24. ↑ 24.0 24.1 Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869. Unknown parameter |month= ignored (help)
  25. ↑ Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. Unknown parameter |month= ignored (help)


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