Postpericardiotomy syndrome
Postpericardiotomy syndrome | |
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A 3D still showing the pericardium layer. | |
Specialty | Cardiology/immunology |
Postpericardiotomy syndrome (PPS) is a medical syndrome referring to an immune phenomenon that occurs days to months (usually 1–6 weeks
Signs and symptoms
The typical signs of post-pericardiotomy syndrome include
Other signs include
Complications
Complications include
Pathogenesis
The cause is believed to be an autoimmune response against damaged cardiac tissue. This is supported by excellent response to immunosuppressive (steroid) therapy.[4]
This condition is a febrile illness caused by immune attack of the
Diagnosis
A chest X-ray might depict pleural effusion, pulmonary infiltration, or pericardial effusion.[2]
During medical doctor examination, a
Treatment
Colchicine
Colchicine has been used effectively to prevent pericarditis, and inflammation that follows surgery of the pericardium.[5] Although no current drug on the market prevents post-pericardiotomy syndrome, colchicine seems to provide an effective and safe way to treat pericarditis by reducing inflammation.[6] Colchicine is a natural product extracted from plants, and is a secondary metabolite (an organic compound not directly related to growth and development in an organism).[5]
Colchicine interferes with the inflammatory process by altering several important steps in the pathway. Microtubules are structural components of the cytoskeleton that lengthen and shrink for important cell functions. Colchicine binds to β- tubulin and forms tubulin-colchicine complexes.,[5][6] These complexes interfere with microtubule formation microtubules. Low doses of colchicine can inhibit the formation of microtubules, while high doses depolymerize or break down a polymer to a monomer.[7] Therefore, any process involving cytoskeleton change, including mitosis and motility of white blood cells, are highly impacted.[citation needed]
Microtubule disruption decrease neutrophil adhesion, an important step for inflammation.[7] Neutrophils are recruited to the target location of inflammation via signals from the endothelium where they adhere and play a role in the inflammatory response. Colchicine diminishes neutrophil adhesion by decreasing expression of selectins, a family of cell adhesion molecules.[7] In addition, colchicine prevents the movement and secretion of intercellular granules, substances, proinflammatory enzymes from neutrophils, thus making a significant impact on inflammatory processes within the body.[6] The high concentration of colchicine in neutrophils, sixteen times greater compared the plasma levels, can account for the positive therapeutic effects.[6]
Many mediators are altered to assist neutrophils during inflammation, including the monokine tumor necrosis factor-alpha (TNFα).[8] Cytokines help stimulate the acute phase reaction in response to inflammation. Colchicine inhibits macrophage production of TNFα, leading to the interference between TNFα and neutrophil interaction.[8] There are many more effects of colchicine that are currently under research, and some aspects of this metabolite are not fully understood.[citation needed]
There was great hope that Colchicine could be a primary preventive measure in treating Post-Pericardiotomy Syndrome due to its anti-inflammatory effects.[6] In the COPPS-2 trial, however, perioperative use of colchicine compared with placebo reduced the incidence of postpericardiotomy syndrome but not of postoperative AF or postoperative pericardial/pleural effusion. The increased risk of gastrointestinal adverse effects reduced the potential benefits of colchicine in this setting. Thus colchicine is not likely going to be the ideal way to prevent this problem.[9]
Epidemiology
More common in children and often common in patients receiving cardiac operations that involves opening the pericardium.
See also
- Skin lesion
- Dressler syndrome
References
- ^ a b c d e f g M. Silvana Horenstein (April 30, 2009). "Postpericardiotomy syndrome". eMedicine from WebMD.
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(help) - ^ a b c Marc. E. Kaminsky; Rodan B.; Osborn D.; Chen J.; Sealy W.; Putman C. "Postcardiotomy syndrome" (PDF). American Journal of Roentgenology.
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(help)[permanent dead link] - ISBN 978-0-7216-2921-6.
- ^ Heffner, John (2010). Pleural Effusions Following Cardiac surgery. UpToDate.
- ^ a b c Eur Heart, J. (2009). Colchicine for pericarditis: hype or hope? Oxford Journal. Vol 30. 532-539.
- ^ a b c d e Eur Heart, J. (2010) Colchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multiculture, randomized, double-blind, placebo controlled trial. Oxford Journal. Vol 31. 2749-2754.
- ^ a b c Spyridon Deftereos, S., Giannopoulos, G., Papoutsidakis, N., Panagopoulou, V., Kossyvakis, C., Raisakis, K., Stefanadis, C. (2013). Colchicine and the heart. Journal of the American College of Cardiology. Vol 62(20), 1817-1825.
- ^ a b Molad, Y. (2002). Update on Colchicine and Its Mechanism of Action. Current Rheumatology Reports. Vol 4. 252-256.
- PMID 25172965.