Post-pericardiotomy Syndrome

Abstract

Post-pericardiotomy syndrome (PPS) occurs in a subgroup of patients who have undergone cardiothoracic surgery and is characterized by fever, pleuritic pain, pleural effusion, and pericardial effusion. It is associated with significant morbidity, and the leading complications include tamponade and constrictive pericarditis. Epidemiologic studies have found that PPS often occurs among younger patients; however, there is a lack of comprehensive risk stratification. It is therefore important to be able to identify patients who are at high risk for developing this disease. The diagnosis is made if patients present with 2 out of the following 5 criteria; fever, pericardial or pleuritic chest pain, pericardial or pleural friction rub, pericardial effusion, and pleural effusion with elevated C-reactive protein (CRP). Pericardial effusion associated with PPS is detected by echocardiography, and cardiac MRI is used for evaluation of pericardial thickening as well as inflammation associated with PPS. These imaging modalities have been invaluable for monitoring the efficacy of treatment in PPS. Aspirin, nonsteroidal anti-inflammatory agents (NSAID), and colchicine are the mainstay of the current treatment for PPS. Although steroids are used for refractory cases of PPS, they are associated with significant side effects when used for long-term treatment of this disease. It is important for future research to focus on identification of clinical, serologic, and genetic markers that may predispose patients to PPS. There is also a need for clinical trials to address the use of targeted immunomodulatory treatment for this disease.

Keywords: Cardiac MRI; Colchicine; Echocardiography; NSAID; Pericardial effusion; Pericardial injury.