Postcardiotomy syndrome

Postcardiotomy syndrome is a complication, coming after surgical interventions on the heart with the opening of okoloserdecna bags and manifested by fever, dry or vpotnye pericarditis, pleuritis, leukocytosis and acceleration ROHE.
Pathogenesis postcardiotomic syndrome is not clear. There are various assumptions. P.F. after mitral commissurotomy consider as rheumatic fever. As the reason postcardiotomic syndrome indicate aseptic inflammation caused by irritation pericardial and pleural blood from the wound. Postcardiotomy syndrome is also considered as a manifestation of autouniversal resulting damage to the heart tissue during surgery. As the operation and postoperative period can foster increased sensitivity to the body, as a result of surgical intervention accumulated denatured protein that leads to the symptoms of an allergic reaction due to autouniversal of the body.
Morphological basis of symptoms in most patients is fibrinous pericarditis (see).
The clinical picture postcardiotomic syndrome characterized by a sudden onset of fever, usually on the second or third week after surgery. The temperature may rise to 38-39°, but is often protracted low-grade nature. The most constant chest pain, often on the left. Sometimes there is only a feeling of heaviness in the heart. A number of patients have chest pain radiating to the left half of the chest, left hand. In more rare cases, the pain is spreading across the surface of the chest. Chest pain may be accompanied by severe shortness of breath. Less commonly, there are cough and hemoptysis. During examination establish a dry, less vpotnye pericarditis; you might find pleurisy, often left.
Pneumonia is more rare manifestations postcardiotomic syndrome. When vpotnye the pericarditis or pleurisy with a puncture usually get serosanguineous liquid, usually sterile. On the ECG can be registered changes, typical for the defeat of the pericardium, and various arrhythmias, perceived by patients as heart rate, and interruptions in the heart.
Some authors refer to the symptoms postcardiotomic syndrome phenomena right heart failure in the form of a significant increase in liver and ascites, edema of the lower extremities. It is more likely that such complications are associated with hemodynamic disturbances in the postoperative period. Determined expressed neutrophilic leucocytosis, accelerated ROHE, rarely hypochromic anemia.
Despite the tendency to relapse, postcardiotomy syndrome occurs usually benign; its duration varies from 1 week up to 1-2 months.
Diagnosis postcardiotomic syndrome may present certain difficulties. P.F. should be differentiated from postoperative thromboembolic complications, activation of rheumatism.
Treatment postcardiotomic syndrome is antibiotics, salicylates, corticosteroids, and symptomatic therapies.