Postpericardiotomy syndrome
Introduction
Introduction to postoperative pericardial incision syndrome Postpericardiotomysyndrome refers to clinical symptoms such as fever, pericarditis, and pleurisy after 1 week of cardiac surgery. This syndrome occurs first in patients with rheumatic heart disease mitral valve surgery and is considered to be a recurrence of rheumatic fever. This syndrome can then occur after cardiac surgery in patients with non-rheumatic heart disease. In the case of a buried cardiac pacemaker pacing catheter causing perforation of the heart, chest blunt trauma, epicardial implantation of a pacemaker, and coronary angioplasty leading to coronary perforation, the clinical manifestation of postoperative pericardial incision syndrome may also occur. feature. The incidence of postoperative pericardial incision syndrome is between 10% and 40%, and the incidence rate of children is higher than that of adults. Recurrence in 5% of patients often occurs within the first 3 months after surgery. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: constrictive pericarditis
Cause
The cause of postoperative pericardial incision syndrome
(1) Causes of the disease
Complications caused by cardiac surgery and other cardiac interventions.
(two) pathogenesis
It occurs more than 2 to 3 weeks after cardiac surgery. It was thought to be related to inflammation caused by blood in the pericardium or related to viral infection, but it has not been fully confirmed. It is thought to be related to hypersensitivity or autoimmunity. Engle et al. It was confirmed that there were anti-myocardial antibodies in the plasma of some patients with pericardial incision: plasma anti-myocardial antibody titers were elevated in approximately 70% of patients with pericardial incision syndrome, and patients with pericardial incision without this syndrome Only 8% rise.
Pericardial tissue of pericardial incision has no specific pathological changes, pericardial injury and hemorrhage may cause pericardial adhesion and thickening, occasional fibrosis causes the pericardial cavity to disappear, causing constrictive pericarditis, after pericardial incision The pericardial fluid of the syndrome may be grass yellow or pink.
Prevention
Pericardial incision prevention
There is no specific preventive method at present, and preoperative prophylactic use of steroids does not effectively prevent postoperative pericardial incision syndrome.
Complication
Complications of postoperative pericardial incision syndrome Complications, constrictive pericarditis
Repeated pericardial tamponade may occur, but constrictive pericarditis rarely occurs.
Symptom
Pericardial incision syndrome symptoms Common symptoms Postoperative fever, abnormal electrocardiogram, ESR, rapid pericarditis, chest pain, pericardial effusion, fatigue
Usually acute onset 2 to 3 weeks after cardiac surgery, characterized by fever, fatigue and chest pain, some cases continue to fever within 1 week after surgery, chest pain is a characteristic of acute pericarditis, chest pain is similar to pleurisy, other non-specific Inflammatory manifestations include accelerated erythrocyte sedimentation rate and elevated polymorphonuclear leukocytes. Almost all patients can hear pericardial friction during the first few days after cardiac surgery. Most of them disappear within 1 week without this syndrome. Pericardial infiltration after cardiac surgery. Blood is extremely common, 56% to 84% of patients have pericardial effusion within 10 days after surgery, atypical cases can only have fever, ECG changes and erythrocyte sedimentation rate, no post-sternal pain and pericardial friction, this syndrome can recur, 5 % of patients with recurrence often appear within the first 3 months after surgery.
Examine
Examination of postoperative pericardial incision syndrome
1. Increased white blood cell count (10,000 to 15,000/mm3), with neutral increase.
2. The blood cell sedimentation rate is increased.
3. C-reactive protein is elevated.
4. Immunofluorescence technique Anti-myocardial antibodies were found in the blood.
5. X-ray: The heart is moderately enlarged and has pericardial effusion. One third of patients had left or bilateral pleural effusions, and 1/10 had pulmonary infiltration.
6. Echocardiography: Pericardial effusion.
7. Electrocardiogram: non-specific ST-T changes and paroxysmal atrial tachycardia.
Diagnosis
Diagnosis and differentiation of postoperative pericardial incision syndrome
The diagnosis of postoperative pericardial incision syndrome is a rule of exclusion. All other causes of fever, discomfort and chest pain should be fully considered and excluded before diagnosis.
The disease needs to be differentiated from other causes after surgery, including fever caused by infection.
