Postpericardiotomy syndrome

Postpericardiotomy syndrome
Classification and external resources
ICD-9-CM	429.4
eMedicine	article/891471
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Postpericardiotomy syndrome (PPS) is a medical syndrome referring to an immune phenomenon that occurs days to months (usually 1–6 weeks) after surgical incision of the pericardium (membranes encapsulating the human heart). PPS can also be caused after a trauma, a puncture of the cardiac or pleural structures (such as a bullet or stab wound), after percutaneous coronary intervention (such as stent placement after a myocardial infarction or heart attack), or due to pacemaker or pacemaker wire placement.

The typical signs of post-pericartiotomy syndrome include fever, pleuritis (with possible pleural effusion), pericarditis (with possible pericardial effusion), occasional but rare pulmonary infiltrates, and fatigue. Cough, pleuritic or retrosternal chest pain, joint pain and decreased oxygen saturation can also be seen in some cases. One problem with this definition is that it is so non specific.

During medical doctor examination,a pericardial friction rub can be auscultated indicating pericarditis. Auscultation of the lungs can show crackles indicating pulmonary infiltration, and there can be retrosternal/pleuritic chest pain worse on inspiration (breathing in). Patient can also depict sweating (diaphoresis) and agitation or anxiety.

A chest X-ray might depict pleural effusion, pulmonary infiltration, or pericardial effusion.

This condition is a febrile illness caused by immune attack of the pleura and the pericardium. Possible cell mediated immunity led by Helper T-cells and Cytotoxic T-cells is postulated to be important in the pathogenesis of this condition. There is also possibility of anti-cardiac antibodies created idiopathically, or due to concurrent cross-reactivity of the antibodies produced against viral antigens, however the latter assumption is not fool-proof or completely reliable due to conflicting studies. It is entirely possible the autoimmune cause is an epiphenomenon and there is a more simple, more likely explanation like the impact of retained blood complications. It is well described that unevaluated blood is often retained around the heart due in part to clogged chest tubes. This blood undergoes an intense inflammatory response in part due to coagulation, and also to hemolysis, resulting in reactive oxygen species that can damage the surface of the heart and pericardium, contributing to pleural effusions, pericardial effusions, and postoperative atrial fibrillation. In light of newer understandings of the cause, intrapericardial inflammation as related to retained blood, and less likely from an immune response, it may be advisable for investigators to re-think how to best describe and develop treatments for this syndrome.

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