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Postpericardiotomy Syndrome FREE

CLAIRE L. HAMMEL, M.D.; WILLIAM S. LYONS, M.D.
[+] Author Affiliations

Submitted for publication Nov. 8, 1961.

Present address: Dr. Claire L. Hammel, M.D., Pediatric Research Laboratory, University Hospital, University of Maryland, Redwood and Greene St., Baltimore, Md.


Am J Dis Child. 1962;104(4):385-390. doi:10.1001/archpedi.1962.02080030387010.
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The postpericardiotomy syndrome is a pleuropericarditis of uncertain etiology and pathogenesis befalling some patients who have undergone cardiac surgery. The majority of reported cases have occurred after mitral commissurotomy in adult patients with rheumatic heart disease,1-4 and thus the syndrome's original name, the "postcommissurotomy" syndrome. More recently has it been documented after surgery for congenital heart disease,4-8 although no reports have appeared in the pediatric literature to date. With the increasing amenability of congenital heart defects to surgical correction, the pediatrician's awareness of this postoperative complication becomes increasingly important. The purpose of this paper is to describe the syndrome as it occurred in a 13-year-old girl after repair of an atrial septal defect, to review the literature, and to speculate on the pathogenesis of this interesting entity.

Report of a Case  A 13-year-old Negro girl was admitted to the Children's Hospital of the District of Columbia on Feb.

REFERENCES

Soloff, L. A.; Zatuchni, J.; Janton, H.; O'Neill, T. J. E., and Glover, R. P.:  Reactivation of Rheumatic Fever Following Mitral Commissurotomy , Circulation 8:481-493 ( (Oct.) ) 1953;.
Elster, S. K.; Wood, H. F., and Seely, R. D.:  Symposium on Rheumatic Fever and Rheumatic Heart Disease: Clinical and Laboratory Manifestations of the Postcommissurotomy Syndrome , Amer. J. Med. 17:826-838 ( (Dec.) ) 1954;.
Dresdale, D. T.; Ripstein, C. B.; Guzman, S. V., and Greene, M. A.:  The Postcardiotomy Syndrome in Patients with Rheumatic Heart Disease: Cortisone as a Prophylactic and Therapeutic Agent , Amer. J. Med. 21:57-74 ( (July) ) 1956;.
Bailey, C. P.: Surgery of the Heart , Philadelphia, Lea & Febiger, Publishers, 1955;, p. 428.
Ito, T.; Engle, M. A., and Goldberg, H. P.:  The Postpericardiotomy Syndrome Following Surgery for Nonrheumatic Heart Disease , Circulation 17:549-556 ( (April) ) 1958;.
Milstein, B. B., and Brock, R.:  The Operative Management of Pulmonary Valvotomy for Pulmonary Valve Stenosis with Normal Aortic Root , Guy. Hosp. Rep. 104:1-18, 1955;.
Johnson, J. L.:  Postpericardiotomy Syndrome in Congenital Heart Deformities , Amer. Heart J. 57:643-653 ( (May) ) 1959;.
Larson, D. L.:  Relation of the Postcommissurotomy Syndrome to the Rheumatic State , Circulation 15:203-209 ( (Feb.) ) 1957;.
Papp, C., and Zion, M. M.:  The Postcommissurotomy Syndrome , Brit. Heart J. 18:153-165 ( (April) ) 1956;.
Dressler, W.:  Idiopathic Recurrent Pericarditis: Comparison with the Postcommissurotomy Syndrome; Considerations of Etiology and Treatment , Amer. J. Med. 18:591-601 ( (April) ) 1955;.
Lisan, P.; Reale, A., and Likoff, W.:  The Postmitral Commissurotomy Syndrome: A 4-Year Clinical, Pathologic and Serologic Study and Its Relation to Restenosis , Ann. Intern. Med. 50:1352-1358 ( (June) ) 1959;.
Coblentz, B.; Hillemand, B., and Lenegre, J.:  Thoracic and Articular Pains After Mitral Commissurotomy: Nature and Prognosis of the Post Commissurotomy Syndrome , Arch. Mal. Coeur 49: 535-550 ( (June) ) 1956;.
De Roover, P., and Lacquet, A.:  Pericarditis Following Pneumonectomy for Pulmonary Tuberculosis , Brit. J. Dis. Chest 53:356-359 ( (Oct.) ) 1959;.
Epstein, S.:  Is the Postcommissurotomy Syndrome of Rheumatic Origin? A.M.A. Arch. Intern. Med. 99:253-259 ( (Feb.) ) 1957;.
Dressler, W.; Yurkofsky, J., and Starr, M. C.:  Hemorrhagic Pericarditis, Pleurisy, and Pneumonia Complicating Recent Myocardial Infarction , Amer. Heart J. 54:42-49 ( (July) ) 1957;.
Dressler, W.:  The Post-Myocardial-Infarction Syndrome: A Report on 44 Cases , A.M.A. Arch. Intern. Med. 103:28-42 ( (Jan.) ) 1959;.
Dressler, W.:  Flare-Up of Pericarditis Complicating Myocardial Infarction After 2 Years of Steroid Therapy , Amer. Heart J. 57:501-506 ( (April) ) 1959;.
Goodkind, M. J.; Bloomer, W. E., and Goodyer, A. V. N.:  Recurrent Pericardial Effusion After Nonpenetrating Chest Trauma , New Engl. J. Med. 263:874-881 ( (Nov. 3) ) 1960;.
Segal, F., and Tabatznik, B.:  The Postpericardiotomy Syndrome Following Penetrating Stab Wounds of the Chest: Comparison with the Postcommissurotomy Syndrome , Amer. Heart J. 59:175-183 ( (Feb.) ) 1960;.
Mason, L. B.; Warshauer, S. E., and Williams, R. W.:  Stab Wound of the Heart with Delayed Hemopericardium , J. Thor. Cardiov. Surg. 29:524-527 ( (May) ) 1955;.
Drinker, C. K., and Field, M. E.:  Absorption from the Pericardial Cavity , J. Exp. Med. 53:143-150 ( (Jan.) ) 1931;.
Stewart, H. J.; Crane, N. F., and Deitrick, J. E.:  Absorption from the Pericardial Cavity in Man , Amer. Heart J. 16:198-202 ( (Aug.) ) 1938;.
Proudfit, W. L., and Effler, D. B.:  Diagnosis and Treatment of Cardiac Pericarditis by Pericardial Biopsy , J.A.M.A. 161:188-192 ( (May 19) ) 1956;.
Bower, B. D.; Gerrard, J. W., and MacGregor, M. E.:  Acute Benign Pericarditis: A Report of 4 Cases in Childhood , Brit. Med. J. 1:244-247 ( (Jan. 31) ) 1953;.
Willius, F. A.:  Acute Sero-Fibrinous Pericarditis Secondary to Acute Pharyngitis , Proc. Mayo Clin. 9:637-640 ( (Oct. 17) ) 1934;.
Finkelstein, D., and Klainer, M. J.:  Pericarditis Associated with Atypical Pneumonia , Amer. Heart J. 28:385-394 ( (Sept.) ) 1944;.
Nathan, D. A., and Dathe, R. A.:  Pericarditis with Effusion Following Infections of the Upper Respiratory System , Amer. Heart J. 31:115-130 ( (Feb.) ) 1946;.
Hein, G. E., and Reavis, J. C.:  Direct Electrocardiograms from the Human Heart in Situ , Circulation 1:964-969 ( (April) ) 1950;.
Godfrey, J.:  Myocardial Involvement in Acute Nonspecific Pericarditis: A Report of 3 Cases , Ann. Intern. Med. 35:1336-1345 ( (Dec.) ) 1951;.
Covey, G. W.:  Fiedler's Myocarditis , Amer. J. Clin. Path 12:160-165 ( (March) ) 1942;.
McKinlay, C. A.:  Allergic Carditis, Pericarditis, and Pleurisy: Report of a Case of Serum Sickness with Predominant Cardiac Manifestations and Symptomatic Recovery , J. Lancet 68:61-65 ( (Feb.) ) 1948;.
Zivitz, H., and Oshlag, J. A.:  Eosinophilic Pleural Effusion and Pericarditis with Effusion in an Allergic Patient , J. Allergy 20:136-143 ( (March) ) 1949;.
Lawrence, H. S.:  The Delayed Type of Allergic Inflammatory Response , Amer. J. Med. 20:428-447 ( (March) ) 1956;.
Geever, E. F.; Neuberger, K. T., and Rutledge, E. K.:  Atypical Pulmonary Inflammatory Reactions , Dis. Chest 19:325-338 ( (March) ) 1951;.

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References

Soloff, L. A.; Zatuchni, J.; Janton, H.; O'Neill, T. J. E., and Glover, R. P.:  Reactivation of Rheumatic Fever Following Mitral Commissurotomy , Circulation 8:481-493 ( (Oct.) ) 1953;.
Elster, S. K.; Wood, H. F., and Seely, R. D.:  Symposium on Rheumatic Fever and Rheumatic Heart Disease: Clinical and Laboratory Manifestations of the Postcommissurotomy Syndrome , Amer. J. Med. 17:826-838 ( (Dec.) ) 1954;.
Dresdale, D. T.; Ripstein, C. B.; Guzman, S. V., and Greene, M. A.:  The Postcardiotomy Syndrome in Patients with Rheumatic Heart Disease: Cortisone as a Prophylactic and Therapeutic Agent , Amer. J. Med. 21:57-74 ( (July) ) 1956;.
Bailey, C. P.: Surgery of the Heart , Philadelphia, Lea & Febiger, Publishers, 1955;, p. 428.
Ito, T.; Engle, M. A., and Goldberg, H. P.:  The Postpericardiotomy Syndrome Following Surgery for Nonrheumatic Heart Disease , Circulation 17:549-556 ( (April) ) 1958;.
Milstein, B. B., and Brock, R.:  The Operative Management of Pulmonary Valvotomy for Pulmonary Valve Stenosis with Normal Aortic Root , Guy. Hosp. Rep. 104:1-18, 1955;.
Johnson, J. L.:  Postpericardiotomy Syndrome in Congenital Heart Deformities , Amer. Heart J. 57:643-653 ( (May) ) 1959;.
Larson, D. L.:  Relation of the Postcommissurotomy Syndrome to the Rheumatic State , Circulation 15:203-209 ( (Feb.) ) 1957;.
Papp, C., and Zion, M. M.:  The Postcommissurotomy Syndrome , Brit. Heart J. 18:153-165 ( (April) ) 1956;.
Dressler, W.:  Idiopathic Recurrent Pericarditis: Comparison with the Postcommissurotomy Syndrome; Considerations of Etiology and Treatment , Amer. J. Med. 18:591-601 ( (April) ) 1955;.
Lisan, P.; Reale, A., and Likoff, W.:  The Postmitral Commissurotomy Syndrome: A 4-Year Clinical, Pathologic and Serologic Study and Its Relation to Restenosis , Ann. Intern. Med. 50:1352-1358 ( (June) ) 1959;.
Coblentz, B.; Hillemand, B., and Lenegre, J.:  Thoracic and Articular Pains After Mitral Commissurotomy: Nature and Prognosis of the Post Commissurotomy Syndrome , Arch. Mal. Coeur 49: 535-550 ( (June) ) 1956;.
De Roover, P., and Lacquet, A.:  Pericarditis Following Pneumonectomy for Pulmonary Tuberculosis , Brit. J. Dis. Chest 53:356-359 ( (Oct.) ) 1959;.
Epstein, S.:  Is the Postcommissurotomy Syndrome of Rheumatic Origin? A.M.A. Arch. Intern. Med. 99:253-259 ( (Feb.) ) 1957;.
Dressler, W.; Yurkofsky, J., and Starr, M. C.:  Hemorrhagic Pericarditis, Pleurisy, and Pneumonia Complicating Recent Myocardial Infarction , Amer. Heart J. 54:42-49 ( (July) ) 1957;.
Dressler, W.:  The Post-Myocardial-Infarction Syndrome: A Report on 44 Cases , A.M.A. Arch. Intern. Med. 103:28-42 ( (Jan.) ) 1959;.
Dressler, W.:  Flare-Up of Pericarditis Complicating Myocardial Infarction After 2 Years of Steroid Therapy , Amer. Heart J. 57:501-506 ( (April) ) 1959;.
Goodkind, M. J.; Bloomer, W. E., and Goodyer, A. V. N.:  Recurrent Pericardial Effusion After Nonpenetrating Chest Trauma , New Engl. J. Med. 263:874-881 ( (Nov. 3) ) 1960;.
Segal, F., and Tabatznik, B.:  The Postpericardiotomy Syndrome Following Penetrating Stab Wounds of the Chest: Comparison with the Postcommissurotomy Syndrome , Amer. Heart J. 59:175-183 ( (Feb.) ) 1960;.
Mason, L. B.; Warshauer, S. E., and Williams, R. W.:  Stab Wound of the Heart with Delayed Hemopericardium , J. Thor. Cardiov. Surg. 29:524-527 ( (May) ) 1955;.
Drinker, C. K., and Field, M. E.:  Absorption from the Pericardial Cavity , J. Exp. Med. 53:143-150 ( (Jan.) ) 1931;.
Stewart, H. J.; Crane, N. F., and Deitrick, J. E.:  Absorption from the Pericardial Cavity in Man , Amer. Heart J. 16:198-202 ( (Aug.) ) 1938;.
Proudfit, W. L., and Effler, D. B.:  Diagnosis and Treatment of Cardiac Pericarditis by Pericardial Biopsy , J.A.M.A. 161:188-192 ( (May 19) ) 1956;.
Bower, B. D.; Gerrard, J. W., and MacGregor, M. E.:  Acute Benign Pericarditis: A Report of 4 Cases in Childhood , Brit. Med. J. 1:244-247 ( (Jan. 31) ) 1953;.
Willius, F. A.:  Acute Sero-Fibrinous Pericarditis Secondary to Acute Pharyngitis , Proc. Mayo Clin. 9:637-640 ( (Oct. 17) ) 1934;.
Finkelstein, D., and Klainer, M. J.:  Pericarditis Associated with Atypical Pneumonia , Amer. Heart J. 28:385-394 ( (Sept.) ) 1944;.
Nathan, D. A., and Dathe, R. A.:  Pericarditis with Effusion Following Infections of the Upper Respiratory System , Amer. Heart J. 31:115-130 ( (Feb.) ) 1946;.
Hein, G. E., and Reavis, J. C.:  Direct Electrocardiograms from the Human Heart in Situ , Circulation 1:964-969 ( (April) ) 1950;.
Godfrey, J.:  Myocardial Involvement in Acute Nonspecific Pericarditis: A Report of 3 Cases , Ann. Intern. Med. 35:1336-1345 ( (Dec.) ) 1951;.
Covey, G. W.:  Fiedler's Myocarditis , Amer. J. Clin. Path 12:160-165 ( (March) ) 1942;.
McKinlay, C. A.:  Allergic Carditis, Pericarditis, and Pleurisy: Report of a Case of Serum Sickness with Predominant Cardiac Manifestations and Symptomatic Recovery , J. Lancet 68:61-65 ( (Feb.) ) 1948;.
Zivitz, H., and Oshlag, J. A.:  Eosinophilic Pleural Effusion and Pericarditis with Effusion in an Allergic Patient , J. Allergy 20:136-143 ( (March) ) 1949;.
Lawrence, H. S.:  The Delayed Type of Allergic Inflammatory Response , Amer. J. Med. 20:428-447 ( (March) ) 1956;.
Geever, E. F.; Neuberger, K. T., and Rutledge, E. K.:  Atypical Pulmonary Inflammatory Reactions , Dis. Chest 19:325-338 ( (March) ) 1951;.

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