Đang tải... (xem toàn văn)
Postoperative pericardial effusion: frequent complication after HS. Early (15 th postoperative day): Postpericardiotomy syndrome Pericardial effusions resulting in cardiac tamponade (CT) are uncommon after open heart surgery (OHS).
POSTOPERATIVE PERICARDIAL EFFUSIONPOSTPERICARDIOTOMY SYNDROME Buøi Gio An.MD INTRODUCTION Postoperative pericardial effusion: frequent complication after HS Early (15 postoperative day): Postpericardiotomy syndrome Pericardial effusions resulting in cardiac tamponade (CT) are uncommon after open heart surgery (OHS) INTRODUCTION Postpericardial injury syndrome (PPIS): Pericarditis or pericardial effusion that results from recent or earlier injury of the pericardium PPIS: Postmyocardial infarction syndrome: Dressler's syndrome Postpericardiotomy syndrome (PPS) Post-traumatic pericarditis Postpericardiotomy syndrome (PPS) A febrile illness with pericardial+/-pleural reactions, develops after surgery involving pericardiotomy The term “postpericardiotomy syndrome” was substituted for the previous “postcardiotomy syndrome”: syndrome can occur after the pericardium is opened even if the heart is not invaded.EX: CA, insertion of a pacing lead, ablation of an aberrant pathway… HISTORY O Henry Janton (1952)-Louis A Soloff(1953): First description of PPS in patient with rheumatic induced mitral valve stenosis who had undergone mitral valvuloplasty Reactivation of the rheumatic process! 1956 -Dressler W: A post-AMI syndrome: idiopathic, recurrent, benign pericarditis 1980-Engle: A possible etiology is autoimmune process +/- viral infection Anti-heart antibody-Antiviral antibody 1980 Clapp SK: Relationship between postpericardiotomy syndrome and pericardial effusion 1990-Horneffer PJ: A randomized placebo-controlled trial (RCT) of NSAIDs in treatment of postpericardiotomy syndrome after cardiac operations (J Thorac Cardiovasc Surg 1990 Aug;100(2):292-6) HISTORY 1992-Webber SA : Cardiopulmonary bypass (CPB) ~ PPS 1993-Velander M: Percutaneous transluminal coronary angioplasty ~PPS 1994-Hargreaves M: Transvenous pacemaker insertion ~PPS 1994-Wilson NJ: RCT in effectiveness of corticosteroids 1998- Burgwardt K: PPS following minimally invasive coronary artery bypass EPIDEMIOLOGY Age: all age, uncommon in < years Gender: no different Mortality/ morbidity: Almost self-limited Life-threatening pericardial tamponade (1%) Cardiac repair ( CHD, Acquired HD), transluminal CA, pacemaker insertion… Onset: Usually 1-6 weeks after surgery Median postoperative time ~ weeks ,range from to 52 weeks Duration: Median 22 days, range from to 100 days Recurrence: 21% ,1-3months post-operative,7 year follow-up (Clinical features and long-term natural history of the postpericardiotomy syndrome – Nishimura RA - Int J Cardiol - 01-NOV-1983; 4(4): 443-54 (From NIH/NLM MEDLINE) Frequency: vary Incidence PPS Post-operative PE Engle 1980, prospective study,chidren n=400 27% 3.5%(if