eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Postpericardiotomy Syndrome: Follow-up

Author: M Silvana Horenstein, MD, Consulting Staff, Department of Pediatrics, University of Texas Medical School Houston; Medical Doctor Consultant, Legacy Department, Best Doctors, Inc
Contributor Information and Disclosures

Updated: Apr 30, 2009

Follow-up

Further Inpatient Care

  • Inpatient care of patients with postpericardiotomy syndrome (PPS) is indicated in more severe cases, such as patients with symptoms and signs indicative of tamponade.
  • After drainage of the pericardial effusion and improvement in the clinical symptoms, most patients can be treated on an outpatient basis.

Further Outpatient Care

  • Bed rest and otherwise restricted physical activity may be indicated. Limit activity at least until resolution of the acute symptoms and findings.

Inpatient & Outpatient Medications

  • Outpatient medications can include aspirin, prednisone, or indomethacin.

Transfer

  • Patients refractory to medical management require transfer to a facility that has a pediatric cardiothoracic surgeon available. These patients may require a surgical pericardial window.

Deterrence/Prevention

  • Currently, no known preventative therapy is available for postpericardiotomy syndrome.
  • A randomized controlled trial evaluating the use of colchicine to prevent postpericardiotomy syndrome in patients undergoing cardiopulmonary bypass did not find a statistically significant difference from placebo.27 However, the authors noted a trend toward significance that may be more evident with larger study, which is currently underway.28

Complications

  • Cardiac tamponade is a life-threatening complication of postpericardiotomy syndrome. Emergent pericardiocentesis and drainage of pericardial effusion is necessary. Tamponade occurs in approximately 1% of patients with postpericardiotomy syndrome.
  • Constrictive pericarditis occurs late postoperatively in fewer than 0.5% of patients but may not be related to postpericardiotomy syndrome. The high prevalence of postpericardiotomy syndrome and quite low prevalence of constriction suggests that a direct association is unlikely. With constriction, the pericardium becomes thickened and adherent to the heart and restricts filling of the ventricles. A pericardiectomy may be required for treatment.
  • Patients with pain from the inflammatory response may demonstrate splinting during breathing. This can result in hypoxemia. Monitor oxygen saturation by pulse oximetry in patients presenting with these findings.
  • Coronary artery bypass grafting is an unusual procedure in children. Occlusion of the graft is reported as a rare, but fatal, complication of postpericardiotomy syndrome.

Prognosis

  • Most cases resolve within a few weeks. Rarely, symptoms may occur for more than 6 months.
  • Relapse may occur after tapering anti-inflammatory medications. Relapse is estimated to occur in 10-15% of patients. Most recurrences occur within 6 months of the initial surgery.

Patient Education

  • Instruct caregivers of children who have undergone cardiac surgery on warning signs of postpericardiotomy syndrome. They should contact their physician if fevers, chest pain, fatigue, weight loss, or shortness of breath develop in these children.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose or adequately treat postpericardiotomy syndrome (PPS)
  • Failure to diagnose or treat impending or manifest cardiac tamponade
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Kelly S Skoumal, DO, MS, FAAP; John W Graneto, DO, FACEP, FAAP; and David A Lewis, MD, FAAP, FACC, to the original writing and development of this article.



More on Postpericardiotomy Syndrome

Overview: Postpericardiotomy Syndrome
Differential Diagnoses & Workup: Postpericardiotomy Syndrome
Treatment & Medication: Postpericardiotomy Syndrome
Follow-up: Postpericardiotomy Syndrome
Multimedia: Postpericardiotomy Syndrome
References
Further Reading
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Further Reading

The European Society of Cardiology have established guidelines for the diagnosis and management of pericardial diseases.

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Keywords

postpericardiotomy syndrome, PPS, postcardiac injury syndrome, cardiac tamponade, pericardium surgery, pericardial effusion, pleural effusion, pneumonitis, friction rubs, pleuritic pain, myocardial infarction, Dressler syndrome, coronary stent implantation, epicardial pacemaker leads, transvenous pacemaker leads, blunt trauma, stab wounds, heart puncture, tamponade cardiac tamponade, coxsackie B, adenovirus, cytomegalovirus, pericardial rub, hepatomegaly

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Contributor Information and Disclosures

Author

M Silvana Horenstein, MD, Consulting Staff, Department of Pediatrics, University of Texas Medical School Houston; Medical Doctor Consultant, Legacy Department, Best Doctors, Inc
M Silvana Horenstein, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ira H Gessner, MD, Professor Emeritus, Pediatric Cardiology
Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Hugh D Allen, MD, Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine
Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Gilbert Z Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center
Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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