Asymptomatic Postoperative Pericardial Effusions: Against the Routine Use of Anti-inflammatory Drug Therapy

The management of postoperative pericardial effusion is a common problem in clinical practice—50% to 85% of patients develop effusion after cardiac surgery (1–3). Cardiac tamponade, the most feared complication, occurs in approximately 2% of patients and is observed even among those who have a subacute course and are beyond 7 days after surgery (3). The pathogenesis of postoperative effusions is not completely understood. Early effusions (within 5 to 7 days of surgery) are probably related to pericardial bleeding and perioperative trauma, whereas late effusions are considered the possible consequence of pericarditis. These late effusions often characterize the so-called “postpericardiotomy syndrome” reported after 10% to 45% of heart surgery cases (4).

The postpericardiotomy syndrome was initially described as a condition that followed surgery for rheumatic mitral stenosis (5) and congenital heart defects (6). It is an example of the pericardial injury syndrome, a term that includes different pericardial diseases (late post–myocardial infarction pericarditis and posttraumatic and iatrogenic pericarditis) characterized by an initial insult, usually with pericardial bleeding followed 1 to 3 weeks later by pericarditis with effusion. The pathogenesis of the postpericardiotomy syndrome is presumed to be autoimmune, but alternative hypotheses implicate acquired infection (7, 8). Diagnosis requires the presence of at least 2 of the following: fever lasting beyond the first postoperative week without other causes, pleuritic chest pain, friction rub, pleural effusion, and new or worsening pericardial effusion (4, 7).

Management is largely empirical and …