Bucekova E, Simkova I, Hulman M
Department of Heart Surgery, National Institute of Cardiovacular Diseases, Bratislava, Slovakia.
Bratisl Lek Listy. 2012;113(8):481-5. doi: 10.4149/bll_2012_106.
Postpericardiotomy syndrome is a non specific belated reaction of pericardium, epicardium and pleural cavity after cardiac or pericardial injury. It is considered to be a common complication in cardiosurgery with occurrence of 3 to 30 percent. Most likely, the primary cause is a common immunopathic process. It develops within days or even up to six months after either cardiac or pericardial injury or both.
Echocardiography is the leading method in determination of postpericardiotomy syndrome due to the frequency of occurrence, non- specific clinical symptoms (fever, chest pain, cough, dizziness), inaccurate interpretation of examination methods (ECG, X-ray, laboratory tests). We would like to show how to determine the exactly diagnose, how to treat it and what is prognosis of this illness.
We have performed a retrospective analysis of 1344 patients, who underwent cardiac surgery in the year 2009. The incidence of post- cardiac surgery syndrome was 12.4 %. In 2.6 % of the studied cases, surgical intervention was needed due to a cardiac tamponade. Int other cases similar to acute pericarditis, symptomatic treatment in duration of several weeks or months with non-steroid antireumatics, salicylic acid or colchicine is sufficient. Therapeutic options in refractory forms are long term oral corticoids or pericardiectomy. During our follow-up, pericardiectomy was necessary to perform in one patient.
Postpericardiotomy syndrome, which occurs in early postoperative period, prolongs hospitalisation. In spite of non specific symptoms huge pericardial effusion might be present and can cause cardiac tamponade with haemodynamic failure in later periods. Transthoracic echocardiography is the golden standard in determination of accurate diagnosis (Fig. 6, Ref. 15).
心包切开术后综合征是心脏或心包损伤后心包、心外膜和胸腔的一种非特异性迟发性反应。它被认为是心脏手术中的常见并发症，发生率为3%至30%。最可能的主要原因是一种常见的免疫病理过程。它在心脏或心包损伤或两者损伤后的数天内甚至长达六个月内发生。
由于心包切开术后综合征的发生率、非特异性临床症状（发热、胸痛、咳嗽、头晕）以及检查方法（心电图、X线、实验室检查）的解读不准确，超声心动图是诊断该综合征的主要方法。我们希望展示如何准确诊断、如何治疗以及该疾病的预后情况。
我们对2009年接受心脏手术的1344例患者进行了回顾性分析。心脏手术后综合征的发生率为12.4%。在2.6%的研究病例中，因心脏压塞需要进行手术干预。在其他类似急性心包炎的病例中，使用非甾体类抗风湿药、水杨酸或秋水仙碱进行数周或数月的对症治疗就足够了。难治性病例的治疗选择是长期口服皮质类固醇或心包切除术。在我们的随访中，有一名患者需要进行心包切除术。
心包切开术后综合征发生在术后早期，会延长住院时间。尽管症状不具特异性，但可能存在大量心包积液，并可能在后期导致心脏压塞和血流动力学衰竭。经胸超声心动图是准确诊断的金标准（图6，参考文献15）。
