Advancements in diagnosis and treatment of postpericardiotomy syndrome_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Qi ¹ , XIE Dong ² , FEI Ke ² ,  JIANG Gening ²

1. Department of Thoracic Surgery, Shanghai Shidong Hospital, Shanghai, 200438, P.R.China;
2. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, P.R.China;

Corresponding author：

JIANG Gening, Email: jgnwp@aliyun.com

Keywords：

Postpericardiotomy syndrome; diagnosis; therapy; prevention

DOI：

10.7507/1007-4848.201509049

Video：

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The postpericardiotomy syndrome (PPS) is an inflammation of the pericardium or pleura following a variety of pericardial injuries. The potential pathogenic factors of the PPS are autoimmune, special virus and latent virus infection. PPS is self-limited, but may lead to prolonged hospital stay, readmissions, and need for invasive interventions. The therapy for PSS is mainly empiric anti-inflammatory therapy. The perioperative use of colchicine could reduce the incidence of PPS but is not effective for postoperative atrial fibrillation or postoperative pericardial/pleural effusion. This article mainly analyzes the incidence, risk factors, clinical features, diagnosis and treatment standards, preventive measures and prognosis of PPS.

Citation： ZHOU Qi, XIE Dong, FEI Ke, JIANG Gening. Advancements in diagnosis and treatment of postpericardiotomy syndrome. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(4): 306-309. doi: 10.7507/1007-4848.201509049 Copy

1.	Lehto J, Gunn J, Karjalainen P, et al. Incidence and risk factors of postpericardiotomy syndrome requiring medical attention: The Finland postpericardiotomy syndrome study. J Thorac Cardiovasc Surg, 2015, 149(5): 1324-1329.
2.	Imazio M. The post-pericardiotomy syndrome. Curr Opin Pulm Med, 2012, 18(4): 366-374.
3.	Imazio M, Brucato A, Rovere ME, et al. Contemporary features, risk factors, and prognosis of the post-pericardiotomy syndrome. Am J Cardiol, 2011, 108(8): 1183-1187.
4.	Prince SE, Cunha BA. Postpericardiotomy syndrome. Heart Lung, 1997, 26(2): 165-168.
5.	Heching HJ, Bacha EA, Liberman L. Post-pericardiotomy syndrome in pediatric patients following surgical closure of secundum atrial septal defects: incidence and risk factors. Pediatr Cardiol, 2015, 36(3): 498-502.
6.	Jaworska-Wilczynska M, Abramczuk E, Hryniewiecki T. Postcardiac injury syndrome. Med Sci Monit, 2011, 17(11): CQ13-CQ14.
7.	Cantinotti M, Spadoni I, Assanta N, et al. Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes: a critical review with a special emphasis on paediatric age. J Cardiovasc Med (Hagerstown), 2014, 15(12): 847-854.
8.	Bajaj BP, Evans KE, Thomas P. Postpericardiotomy syndrome following temporary and permanent transvenous pacing. Postgrad Med J, 1999, 75(884): 357-358.
9.	Yukumi S, Suzuki H, Kashu Y, et al. Postpericardiotomy syndrome after thymothymectomy: report of two cases. Gen Thorac Cardiovasc Surg, 2012, 60(7): 462-464.
10.	Imazio M, Brucato A, Ferrazzi P, et al. Postpericardiotomy syndrome: a proposal for diagnostic criteria. J Cardiovasc Med (Hagerstown), 2013, 14(5): 351-353.
11.	Barbetakis N, Asteriou C, KleontAS A, et al. Post-pericardiotomy syndrome following lung cancer surgery. Interact Cardiovasc Thorac Surg, 2010, 11(6): 871.
12.	Janton OH, Glover RP, O'neill TJ, et al. Results of the surgical treatment for mitral stenosis; analysis of one hundred consecutive cases. Circulation, 1952, 6(3): 321-333.
13.	Ito T, Engle MA, Goldberg HP. Postpericardiotomy syndrome following surgery for nonrheumatic heart disease. Circulation, 1958, 17(4, Part 1): 549-556.
14.	Finkelstein Y, Shemesh J, Mahlab K, et al. Colchicine for the prevention of postpericardiotomy syndrome. Herz, 2002, 27(8): 791-794.
15.	Imazio M, Trinchero R, Brucato A, et al. Colchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. Eur Heart J, 2010, 31(22): 2749-2754.
16.	Imazio M, Brucato A, Ferrazzi P, et al. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA, 2014, 312(10): 1016-1023.
17.	Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol, 2013, 168(2): 648-652.
18.	Erlich JF, Paz Z. Postpericardial injury syndrome: an autoimmune phenomenon. Clin Rev Allergy Immunol, 2010, 38(2-3): 156-158.
19.	McCabe JC, Ebert PA, Engle MA, et al. Circulating heart-reactive antibodies in the postpericardiotomy syndrome. J Surg Res, 1973, 14(2): 158-164.
20.	Jaworska-Wilczynska M, Magalska A, Piwocka K, et al. Low interleukin-8 level predicts the occurrence of the postpericardiotomy syndrome. PloS One, 2014, 9(10): e108822.
21.	Gill PJ, Forbes K, Coe JY. The effect of short-term prophylactic acetylsalicylic acid on the incidence of postpericardiotomy syndrome after surgical closure of atrial septal defects. Pediatr Cardiol, 2009, 30(8): 1061-1067.
22.	Mott AR, Fraser CD Jr, Kusnoor AV, et al. 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, 2001, 37(6): 1700-1706.
23.	Wendelin G, Fandl A, Beitzke A. High-dose intravenous immunoglobulin in recurrent postpericardiotomy syndrome. Pediatr Cardiol, 2008, 29(2): 463-464.
24.	Eguchi T, YoshidA K, Hamanaka K, et al. Colchicine as an effective treatment for postpericardiotomy syndrome following a lung lobectomy. Interact Cardiovasc Thorac Surg, 2010, 11(6): 869-871.
25.	Bunge JJ, Van Osch D, Dieleman JM, et al. Dexamethasone for the prevention of postpericardiotomy syndrome: A DExamethasone for Cardiac Surgery substudy. Am Heart J, 2014, 168(1): 126-131.
26.	Imazio M, Brucato A, Rovere ME, et al. Colchicine prevents early postoperative pericardial and pleural effusions. Am Heart J, 2011, 162(3): 527-532.
27.	Duarte JH. Interventional cardiology: Colchicine therapy prevents postpericardiotomy syndrome but not postoperative atrial fibrillation. Nat Rev Cardiol, 2014, 11(11): 620.

1. Lehto J, Gunn J, Karjalainen P, et al. Incidence and risk factors of postpericardiotomy syndrome requiring medical attention: The Finland postpericardiotomy syndrome study. J Thorac Cardiovasc Surg, 2015, 149(5): 1324-1329.
2. Imazio M. The post-pericardiotomy syndrome. Curr Opin Pulm Med, 2012, 18(4): 366-374.
3. Imazio M, Brucato A, Rovere ME, et al. Contemporary features, risk factors, and prognosis of the post-pericardiotomy syndrome. Am J Cardiol, 2011, 108(8): 1183-1187.
4. Prince SE, Cunha BA. Postpericardiotomy syndrome. Heart Lung, 1997, 26(2): 165-168.
5. Heching HJ, Bacha EA, Liberman L. Post-pericardiotomy syndrome in pediatric patients following surgical closure of secundum atrial septal defects: incidence and risk factors. Pediatr Cardiol, 2015, 36(3): 498-502.
6. Jaworska-Wilczynska M, Abramczuk E, Hryniewiecki T. Postcardiac injury syndrome. Med Sci Monit, 2011, 17(11): CQ13-CQ14.
7. Cantinotti M, Spadoni I, Assanta N, et al. Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes: a critical review with a special emphasis on paediatric age. J Cardiovasc Med (Hagerstown), 2014, 15(12): 847-854.
8. Bajaj BP, Evans KE, Thomas P. Postpericardiotomy syndrome following temporary and permanent transvenous pacing. Postgrad Med J, 1999, 75(884): 357-358.
9. Yukumi S, Suzuki H, Kashu Y, et al. Postpericardiotomy syndrome after thymothymectomy: report of two cases. Gen Thorac Cardiovasc Surg, 2012, 60(7): 462-464.
10. Imazio M, Brucato A, Ferrazzi P, et al. Postpericardiotomy syndrome: a proposal for diagnostic criteria. J Cardiovasc Med (Hagerstown), 2013, 14(5): 351-353.
11. Barbetakis N, Asteriou C, KleontAS A, et al. Post-pericardiotomy syndrome following lung cancer surgery. Interact Cardiovasc Thorac Surg, 2010, 11(6): 871.
12. Janton OH, Glover RP, O'neill TJ, et al. Results of the surgical treatment for mitral stenosis; analysis of one hundred consecutive cases. Circulation, 1952, 6(3): 321-333.
13. Ito T, Engle MA, Goldberg HP. Postpericardiotomy syndrome following surgery for nonrheumatic heart disease. Circulation, 1958, 17(4, Part 1): 549-556.
14. Finkelstein Y, Shemesh J, Mahlab K, et al. Colchicine for the prevention of postpericardiotomy syndrome. Herz, 2002, 27(8): 791-794.
15. Imazio M, Trinchero R, Brucato A, et al. Colchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. Eur Heart J, 2010, 31(22): 2749-2754.
16. Imazio M, Brucato A, Ferrazzi P, et al. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA, 2014, 312(10): 1016-1023.
17. Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol, 2013, 168(2): 648-652.
18. Erlich JF, Paz Z. Postpericardial injury syndrome: an autoimmune phenomenon. Clin Rev Allergy Immunol, 2010, 38(2-3): 156-158.
19. McCabe JC, Ebert PA, Engle MA, et al. Circulating heart-reactive antibodies in the postpericardiotomy syndrome. J Surg Res, 1973, 14(2): 158-164.
20. Jaworska-Wilczynska M, Magalska A, Piwocka K, et al. Low interleukin-8 level predicts the occurrence of the postpericardiotomy syndrome. PloS One, 2014, 9(10): e108822.
21. Gill PJ, Forbes K, Coe JY. The effect of short-term prophylactic acetylsalicylic acid on the incidence of postpericardiotomy syndrome after surgical closure of atrial septal defects. Pediatr Cardiol, 2009, 30(8): 1061-1067.
22. Mott AR, Fraser CD Jr, Kusnoor AV, et al. 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, 2001, 37(6): 1700-1706.
23. Wendelin G, Fandl A, Beitzke A. High-dose intravenous immunoglobulin in recurrent postpericardiotomy syndrome. Pediatr Cardiol, 2008, 29(2): 463-464.
24. Eguchi T, YoshidA K, Hamanaka K, et al. Colchicine as an effective treatment for postpericardiotomy syndrome following a lung lobectomy. Interact Cardiovasc Thorac Surg, 2010, 11(6): 869-871.
25. Bunge JJ, Van Osch D, Dieleman JM, et al. Dexamethasone for the prevention of postpericardiotomy syndrome: A DExamethasone for Cardiac Surgery substudy. Am Heart J, 2014, 168(1): 126-131.
26. Imazio M, Brucato A, Rovere ME, et al. Colchicine prevents early postoperative pericardial and pleural effusions. Am Heart J, 2011, 162(3): 527-532.
27. Duarte JH. Interventional cardiology: Colchicine therapy prevents postpericardiotomy syndrome but not postoperative atrial fibrillation. Nat Rev Cardiol, 2014, 11(11): 620.

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