Post-Pericardiotomy Syndrome: Understanding the Condition

Post-pericardiotomy syndrome (PPS) is a clinical condition that typically occurs at least one week after heart surgery. It is characterized by symptoms such as fever, pericarditis, and pleuritis. The pericardium, a thin membrane that surrounds the heart, must be opened during cardiac procedures to access the heart. Although the exact cause of PPS remains unclear, it is widely believed to be linked to an autoimmune response triggered by the surgical trauma.

Symptoms and Clinical Presentation

Patients commonly begin to experience symptoms around two to three weeks following cardiac surgery. The signs of PPS include fever, mild chills, fatigue, increased mucus production, and chest pain. In some cases, these symptoms may appear within the first week after surgery. Older children with the condition may experience chest pain similar to that seen in pleuritis. Additional non-specific inflammatory indicators, such as elevated erythrocyte sedimentation rate (ESR), are often observed.

It is also common for patients to develop pericardial effusion—fluid accumulation around the heart—within ten days after surgery. This can lead to complications such as cardiac tamponade and right-sided heart failure. Other associated symptoms may include pleural effusion, ascites, abdominal pain, and nausea. Importantly, PPS can recur, with about 5% of patients experiencing a relapse within three months after the initial surgery.

Diagnosis of Post-Pericardiotomy Syndrome

Exclusion-Based Diagnosis

The diagnosis of PPS is primarily one of exclusion. Before confirming PPS, physicians must thoroughly evaluate and rule out other potential causes of postoperative fever, discomfort, and chest pain. These differential diagnoses may include infections, pulmonary embolism, myocardial infarction, or other inflammatory conditions. Only after these possibilities have been carefully considered and eliminated can PPS be confidently identified as the underlying cause.