RESUMO
Postpericardiotomy syndrome is an immune phenomenon that occurs from several days to months after surgical incision of the pericardium. Prominent clinical features include fever, pericarditis, and pleuritis. Of 161 patients with Wolff-Parkinson-White syndrome who underwent surgical treatment, 50 (31%) developed postpericardiotomy syndrome 4-12 days later. Of these 50 patients, 38 had sufficiently complete records for analysis. Significant radiographic abnormalities were present in 30 (79%) of these 38 patients, pericardial effusions in 19 (50%), pleural effusions in 26 (68%), and pulmonary infiltrates in four (10%). These radiographic signs almost always developed within 2 days of the onset of symptoms, either before or after, and were essentially absent in the 76 patients who did not clinically develop the syndrome. Postoperative radiographs can be extremely valuable in first suggesting or confirming the suspicion of postpericardiotomy syndrome.
Assuntos
Cardiopatias/diagnóstico por imagem , Síndrome Pós-Pericardiotomia/diagnóstico por imagem , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Radiografia , Fatores de Tempo , Síndrome de Wolff-Parkinson-White/cirurgiaRESUMO
A 14-year-old boy had a protracted illness characterized by bilateral tenderness and weakness of the extremities; the illness was considered to be a connective tissue disease similar to polymyositis. Not until nine months later, when the patient had new cardiac murmurs, pulmonary edema, and then a cerebrovascular accident, was the true nature of his illness suspected. The diagnosis of left atrial myxoma with the triad of constitutional, obstructive, and embolic effects was confirmed by echocardiographic studies and cardiac catheterization. The tumor was successfully removed.
Assuntos
Doenças do Colágeno/diagnóstico , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Adolescente , Cateterismo Cardíaco , Diagnóstico Diferencial , Ecocardiografia , Átrios do Coração , Humanos , MasculinoRESUMO
The postpericardiotomy syndrome is a febrile illness with pericardial and pleural reaction that either persists or appears beyond the 1st postoperative week. We believe that it begins in the 1st week after intrapericardial cardiac surgery, and that clinical signs of illness correlate with appearance of AHA and with significant rise in titer to AVA. Our present working hypothesis is that myocardial damage with bleeding into the pericardial sac at the time of surgery combines with concurrently acquired or reactivated viral illness to set the stage for the syndrome. The immune response is triggered by viral invasion of traumatized myocardium and an immune response is mounted, not against autologous myocardium per se but against the neo-antigen, the virus-infected myocardium. The illness is self-limited. It sometimes recurs but it seems to leave no sequelae other than the bad memory of a painful postoperative complication that prolonged hospitalization and delayed the realization of the full benefits of that heart operation.
