Postpericardiotomy syndrome following surgery for congenital heart disease
Derek Fyfe, M.D., Ph.D.
Department of Pediatrics and Adolescent Medicine
Douglas S. Moodie, M.D.
Department of Cardiology, Department of Pediatrics and Adolescent Medicine
Carl C. Gill, M.D.
Department of Thoracic and Cardiovascular Surgery
The postpericardiotomy syndrome (PPS) may occur after intrapericardial surgery and is usually characterized by fever and pericardial and pleural effusions as major clinical manifestations.1–3 A similar syndrome has also been observed after myocardial infarction (Dressler’s syndrome),4 and after penetrating or blunt trauma to the pericardium.5 As yet no specific treatment for this syndrome is available and anti-inflammatory agents with supportive medical or surgical measures are generally used when necessary. Although PPS is believed to be a self-limited illness, in some cases it has led to cardiac tamponade and death. In the largest reported series of 400 patients who had undergone intracardiac surgery, PPS occurred in about 27%; it rarely occurs before age 2.6
The recent surgical experience with congenital heart disease at the Cleveland Clinic was reviewed with regard to the frequency and manifestations of the clinically significant PPS.
PPS occurred in 13 of 217 patients after correction of various congenital cardiac lesions (Table). Six of 13 patients had simple secundum atrial septal defects. The other congenital lesions are listed in the Table. The age range was 11 to 47 years (mean, 21.6 years). Nine of the 13 patients were between 11 and 20 years of age. The most frequent presenting symptoms were fever, pleuritic chest pain, and shoulder pain (eight patients). Frequent findings on physical examination were decreased breath sounds (eight patients), and the presence of a pleural or pericardial rub (six patients). Symptoms began between the third and 55th days postoperatively; the mean onset was 16 . . .