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

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

Diagnostic procedures

• electrocardiogram: electrical alternans

Radiology

• chest X-ray for pleural effusion, pulmonary infiltration, pericardial effusion

Management

• colchicine may reduce inflammation (first line)
  • does not reduce pericardial effusion
  • does not reduce pleural effusion
• salicylates &/or glucocorticoids may reduce inflammation
• opiates may reduce pain

More general terms

• postoperative complication
• pericardial disease
• syndrome