postpericardiotomy syndrome

心膜切開後症候群

WordNet

1. a pattern of symptoms indicative of some disease
2. a complex of concurrent things; "every word has a syndrome of meanings"

PrepTutorEJDIC

1. (疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/30 10:39:15」(JST)

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Postpericardiotomy syndrome
Classification and external resources
ICD-9	429.4
eMedicine	article/891471

Postpericardiotomy syndrome (PPS) is a medical syndrome referring to an immune phenomenon that occurs days to months (usually 1–6 weeks) after surgical incision of the pericardium (membranes encapsulating the human heart). PPS can also be caused after a trauma, a puncture of the cardiac or pleural structures (such as a bullet or stab wound), after percutaneous coronary intervention (such as stent placement after a myocardial infarction or heart attack), or due to pacemaker or pacemaker wire placement.

Signs & Symptoms

The typical signs of post-pericartiotomy syndrome include fever, pleuritis (with possible pleural effusion), pericarditis (with possible pericardial effusion), occasional but rare pulmonary infiltrates, and fatigue. Cough, pleuritic or retrosternal chest pain, and decreased oxygen saturation can also be seen in some cases.

Physical findings

During medical doctor examination,a pericardial friction rub can be auscultated indicating precarditis. Auscultation of the lungs can show crackles indicating pulmonary infiltration, and there can be retrosternal/pleuritic chest pain worse on inspiration (breathing in). Patient can also depict sweating (diaphoresis) and agitation or anxiety.

Radiological findings

A chest X-ray might depict pleural effusion, pulmonary infiltration, or pericardial effusion.

Pathogenesis (Disease process)

This condition is a febrile illness caused by immune attack of the pleura and the pericardium. Possible cell mediated immunity led by Helper T-cells and Cytotoxic T-cells is postulated to be important in the pathogenesis of this condition. There is also possibility of anti-cardiac antibodies created idiopathically, or due to concurrent cross-reactivity of the antibodies produced against viral antigens, however the latter assumption is not fool-proof or completely reliable due to conflicting studies.

Epidemiology

Uncommon in children and often common in patients receiving cardiac operations that involves opening the pericardium. CABG surgery is a common culprit.

Complications

Complications include pericarditis, pericardial effusion, pericardial tamponade, pleuritis, and pulmonary infiltration. Of these cardiac tamponade is the most life threatening complication. The pericardial fluid increases intra-pericardial pressure therefore preventing complete expansion of the atria and the ventricles upon the diastole. This causes equilibration of the pressure in all four heart chambers, and results in the common findings of the tamponade which are pulsus paradoxus, Beck's triad of hypotension, muffled heart sounds, and JVD, as well as EKG or Holter monitor findings such as electrical alternans. Physically the patients who progress to severe pericardial tamponade obtundate, become mentally altered, and lethargic. If left untreated, severe cardiac output decrease, vascular collapse, and hypoperfusion of body including the brain results in death.

Prevention

Avoidance of injurious procedures is the only sure way to avoid this syndrome, however PPS by itself it not an indication of the quality of an operation. The mere opening of the pericardium in any form of cardiac operation is enough to cause this syndrome. Post-surgical obeservation and astute patient-physician relationship are great tools to identify the syndome before it progresses to complications such as tamponade.

References

UpToDate Contents

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• 1. 心臓傷害後症候群 post cardiac injury syndromes
• 2. 心臓手術後の胸水 pleural effusions following cardiac surgery
• 3. 心筋梗塞の心膜合併症 pericardial complications of myocardial infarction
• 4. 心膜疾患の病因 etiology of pericardial disease
• 5. 急性心膜炎の治療 treatment of acute pericarditis

English Journal

• The post-pericardiotomy syndrome.

• Imazio M.SourceCardiology Department, Maria Vittoria Hospital, Torino, Italy. massimo_imazio@yahoo.it
• Current opinion in pulmonary medicine.Curr Opin Pulm Med.2012 Jul;18(4):366-74.
• PURPOSE OF REVIEW: The postpericardiotomy syndrome (PPS) is a relatively common complication following cardiac surgery, whose epidemiology is not well known because there are no standardized definitions. The aim of the present study is to review more recent updates on the diagnosis, therapy, prognos
• PMID 22487945

• Postpericardiotomy syndrome after thymothymectomy: report of two cases.

• Yukumi S, Suzuki H, Kashu Y, Okazaki M, Sano Y.SourceDepartment of Surgery, National Hospital Organization, Ehime National Hospital, 366 Yokogawara, Toon, Ehime, 791-0281, Japan, syukumi@ehime-nh.go.jp.
• General thoracic and cardiovascular surgery.Gen Thorac Cardiovasc Surg.2012 Jul;60(7):462-4. Epub 2012 May 8.
• Two cases of postpericardiotomy syndrome (PPS) after thymothymectomy associated with pericardiotomy are described. The incidence of PPS in cardiac operations is reportedly 10-30 %. Although no reports have been described in the English literature, our retrospective analysis revealed similar inciden
• PMID 22566253

Japanese Journal

• 鈍的な胸部外傷後より胸膜炎症状を繰り返した心外傷後症候群の1例

• 南波 亮一,山本 祐介,名和 健,遠藤 勝幸
• 日本呼吸器学会雑誌 = The journal of the Japanese Respiratory Society 47(12), 1161-1165, 2009-12-10
• NAID 10026273333

• Repeated Postpericardiotomy Syndrome Following a Temporary Transvenous Pacemaker Insertion, a Permanent Transvenous Pacemaker Insertion and Surgical Pericardiotomy

• Sasaki Akihiko,Kobayashi Hideyuki,Okubo Toyoyuki,Namatame Yasuhide,Yamashina Akira
• Japanese circulation journal 65(4), 343-344, 2001-03-20
• … The postpericardiotomy syndrome is a well-known complication of opening and manipulating the pericardium. … The occurrence of this syndrome following transvenous pacemaker insertion is very rare, and only 5 cases have been reported to date. … The present patient repeated this syndrome 3 times in a short period following 3 different interventional techniques: a temporary transvenous pacemaker, a permanent transvenous pacemaker and surgical pericardiotomy. …
• NAID 110002567049

Related Links

• Postpericardiotomy Syndrome - Diseases & Conditions ...

Postpericardiotomy Syndrome. Postpericardiotomy syndrome (PPS) is a febrile illness secondary to an inflammatory reaction involving the pleura and pericardium. ... Ira H Gessner, MD Professor Emeritus, Pediatric ...

• postpericardiotomy syndrome - definition of ...

Translations of postpericardiotomy syndrome. postpericardiotomy syndrome synonyms, postpericardiotomy syndrome antonyms. Information about postpericardiotomy syndrome in the free online English dictionary and Bing ? ...

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★リンクテーブル★

リンク元	「心筋梗塞後症候群」「心膜切開後症候群」
関連記事	「syndrome」

「心筋梗塞後症候群」

　　[★]

英

post-myocardial infarction syndrome, postmyocardial infarction syndrome

同

ドレスラー症候群, Dressler症候群, Dressler's syndrome, Dressler syndrome

関

心筋梗塞

概念

• 様々な呼び方がある。(参考1)

• post cardiac injury syndrome PCIS
• Dressler's syndrome
• postpericardiotomy syndrome
• [心筋梗塞後に起こった物について特に]postmyocardial infarction syndrome (Post-MI fibrinous pericarditis)

• 疫学・病因：心臓手術後だけでなく心筋梗塞後や肺塞栓後でも起こり、これらの患者のうちPCISを起こす患者は3.5%であったという報告がある。PCISは歴史的には1956年にDresslerによって急性心筋後、数週間から数ヶ月後に起こると報告されいるが、まれに心筋梗塞後1週間以内に症状が出現することがある。(参考1)　　
• 病態・症状：胸膜痛(pleuritic chest pain)、胸膜摩擦音、発熱、白血球増多、時に胸水・肺浸浸潤影(pulmonary infiltrate)。(参考1)　　←　　心筋梗塞後1週間以内に見られる急性心膜炎とは症状や経過が違うらしい。
• 病態生理：免疫性因子の関与が想定されている。心筋障害により心臓由来の抗原が放出され抗体形成を刺激、免疫複合体を形成後に心膜、胸膜、肺に沈着する。免疫複合体に対して炎症反応が惹起されるのが本態とされる。(参考1)

参考

• 1. [charged] Pericardial complications of myocardial infarction - uptodate [1]

「心膜切開後症候群」

　　[★]

英

postpericardiotomy syndrome

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心膜切開後症候群 : 91 件
心膜切開術後症候群 : 22 件

「syndrome」

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• n.

• 症候群