Methotrexate in recurrent postpericardiotomy syndrome

Zucker, Nili; Levitas, Aviva; Zalzstein, Eli

doi:10.1017/s1047951103000404

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…There is a small group of patients, however, who are refractory to conventional therapy, such as the 2 presented in this report. In such cases, different immunosuppressive or immunomodulatory drugs have been used on the basis of the suspected autoimmune pathogenesis of the disease, including azathioprine, 2-4 methotrexate, 5 and, more recently, anti-IL-1…”

Section: Discussionmentioning

confidence: 99%

“…It is not uncommon, however, for patients to become steroid-dependent or to continue to have pericardial effusion. In such cases, several therapies have been successfully used, including immunosuppressive agents such as azathioprine or methotrexate, [2][3][4][5] interleukin (IL)-1 receptor antagonist, [6][7][8][9][10] anti-tumor necrosis factor (anti-TNF) drugs, 11 and intravenous immunoglobulin (IVIG). [12][13][14][15] Herein, we report on 2 children with refractory postpericardiotomy syndrome who were successfully treated with IVIG.…”

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confidence: 99%

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Intravenous Immunoglobulin Therapy for Refractory Recurrent Pericarditis

Fresno¹,

Peralta

Granados

et al. 2014

Pediatrics

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Recurrent pericarditis is a troublesome complication of idiopathic acute pericarditis and occurs more frequently in pediatric patients after cardiac surgery (postpericardiotomy syndrome). Conventional treatment with nonsteroidal antiinflammatory drugs, corticosteroids, and colchicine is not always effective or may cause serious adverse effects. There is no consensus, however, on how to proceed in those patients whose disease is refractory to conventional therapy. In such cases, human intravenous immunoglobulin, immunosuppressive drugs, and biological agents have been used. In this report we describe 2 patients with refractory recurrent pericarditis after cardiac surgery who were successfully treated with 3 and 5 monthly high-dose (2 g/kg) intravenous immunoglobulin until resolution of the effusion. Our experience supports the effectiveness and safety of this therapy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Intravenous Immunoglobulin Therapy for Refractory Recurrent Pericarditis

Fresno¹,

Peralta

Granados

et al. 2014

Pediatrics

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“…There are anecdotal case reports on the use of methotrexate [168], azathioprine [169,170], as well as high-dose intravenous immunoglobulin [171][172][173][174], in the treatment of steroid-dependent recurrent PPS. Moreover, in chronic recurrent pericarditis, anakinra, a recombinant IL-1b receptor antagonist [175][176][177][178] as well as cyclophosphamide [170] have been successfully used.…”

Section: Medical Treatmentmentioning

confidence: 99%

Postpericardiotomy syndrome after cardiac surgery

Lehto

Kiviniemi

2020

Annals of Medicine

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Postpericardiotomy syndrome (PPS) is a well-known complication after cardiac surgery. The syndrome results in prolonged hospital stay, readmissions, and invasive interventions. Previous studies have reported inconsistent results concerning the incidence and risk factors for PPS due to the differences in the applied diagnostic criteria, study designs, patient populations, and procedure types. In recent prospective studies the reported incidences have been between 21 and 29% in adult cardiac surgery patients. However, it has been stated that most of the included diagnoses in the aforementioned studies would be clinically irrelevant. This challenges the specificity and usability of the currently recommended diagnostic criteria for PPS. Moreover, recent evidence suggests that PPS requiring invasive intervention such as the evacuation of pleural and/or pericardial effusion is associated with increased mortality. In the present review, we summarise the existing literature concerning the incidence, clinical features, diagnostic criteria, risk factors, management, and prognosis of PPS. We also propose novel approaches regarding to the definition and diagnosis of PPS. KEY MESSAGES: 1. Current diagnostic criteria of PPS should be reconsidered, and the analyses should be divided into subgroups according to the severity of the syndrome to achieve more clinically applicable and meaningful results in the future studies. 2. In contrast with the previous presumption, severe PPSdefined as PPS requiring invasive interventionswas recently found to be associated with higher all-cause mortality during the first two years after cardiac surgery. The association with an increased mortality supports the use of relatively aggressive prophylactic methods to prevent PPS. 3. The risk factors clearly increasing the occurrence of PPS are younger age, pleural incision, and valve and ascending aortic procedures when compared to CABG.

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“…Isolated reports point to positive reactions to methotrexate [39], azathioprine, cyclophosphamide, and large doses of intravenous immunoglobulin (IVIG) [40] in the treatment of refractory syndromes. Pericardiocentesis is performed in the case of cardiac tamponade or large pericardial effusions, present for at least one week despite comprehensive treatment (recommendation class Ia, evidence level B, according to ESC 2004) [11].…”

Section: Treatmentmentioning

confidence: 99%

Post-cardiac injury syndrome

Jaworska-Wilczyńska¹,

Kuśmierczyk²,

Abramczuk³

et al. 2013

kitp

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Post-cardiac injury syndrome (PCIS), also known as post-pericardiotomy syndrome, post-myocardial infarction syndrome, or post-commissurotomy syndrome, is a common complication after cardiac surgery, affecting approximately 40% of patients. PCIS occurs several days to several months after the surgical procedure. The syndrome manifests itself as exudative pericardial or pleural effusion with low-grade temperature and elevated inflammatory parameters. It is generally a self-limiting disease with a favorable prognosis, but it can have a relapsing course and be accompanied by life-threatening complications including cardiac tamponade and constrictive pericarditis. Key words: post-cardiac injury syndrome, pericarditis, cardiac tamponade, pleuritis. StreszczenieZespół pourazowy serca (zespół po perikardiotomii, zespół pozawałowy Dresslera, zespół po komisurotomii) to jedno z częstszych powikłań po operacjach kardiochirurgicznych. Dotyczy ok. 40% pacjentów. Zespół charakteryzuje się pogorszeniem samopoczucia, gorączką lub stanami podgorączkowymi, zapaleniem osierdzia i opłucnych oraz podwyższonymi parametrami zapalnymi. Dolegliwości pojawiają się po kilku dniach lub nawet kilku miesiącach od zabiegu. Rokowanie u chorych z zespołem pourazowym serca jest dobre, choć zwykle przedłuża on hospitalizację, może mieć przebieg nawrotowy oraz może powodować groźne powikłania, szczególnie tamponadę serca i zaciskające zapalenie osierdzia. Słowa kluczowe: zespół pourazowy serca, zapalenie osierdzia, tamponada serca, zapalenie opłucnej.

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Methotrexate in recurrent postpericardiotomy syndrome

Cited by 8 publications

References 4 publications

Intravenous Immunoglobulin Therapy for Refractory Recurrent Pericarditis

Intravenous Immunoglobulin Therapy for Refractory Recurrent Pericarditis

Postpericardiotomy syndrome after cardiac surgery

Post-cardiac injury syndrome

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