Materiały źródłowe

• #1 Prevention of pericardial complications after cardiac surgery: myth or reality? | Heart

  https://heart.bmj.com/content/111/8/337.abstract

  Pericardial complications are very common following cardiac surgery. It is estimated that up to 3040% of patients may develop a postpericardiotomy syndrome (PPS) and 5060% of patients show pericardial effusions after cardiac surgery. […] On this basis, prevention of pericardial postoperative complications is of paramount importance in clinical practice. […] The aim of the present systematic review by Malektojari et al is to evaluate the efficacy and safety of proposed preventive strategies for the prevention of such complications with a main focus on PPS, pericardial effusion, pericarditis and POAF.

• #2 Pericardial Effusion | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pericardial-effusion.html

  You can reduce your risk of some of the medical problems that can lead to pericardial effusion. For example, take care of your heart by: […] Many cases of pericardial effusion are not preventable.

• #3 Cardiac Tamponade | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cardiac-tamponade.html

  You can cut your risk for some of the health problems that can lead to cardiac tamponade. For example, take care of your heart by: […] Many cases of cardiac tamponade can’t be prevented, though.

• #4 What Is Pericardial Effusion?

  https://www.icliniq.com/articles/heart-circulatory-health/pericardial-effusion

  The risk of experiencing a pericardial effusion can be reduced by eating a healthy diet and exercising regularly. A balanced diet acts as fuel to the heart providing all the necessary nutrients, while regular exercise keeps the heart running similar to an engine. Depriving the heart of these two basic and fundamental requisites will only call for trouble in the near or late future. If one is already suffering from other cardiovascular diseases, a heart-healthy diet and regular consultations with the cardiologist should be made a priority. […] The pericardial effusion can be controlled or prevented by following some of the following steps such as – – Reducing stress. – Resting. – Eat an anti-inflammatory diet such as – Raw fruits and vegetables. – Eating probiotic-rich foods such as cultured vegetables (like sauerkraut and kimchi), kombucha, coconut kefir, and cultured yogurt. – Eating high-quality protein food. – Consume healthy fats such as coconut oil, olive oil, avocado, nuts, and seeds. – Drink plenty of water daily. – Quit smoking. – Taking natural sleep aids and pain-relievers.

• #5 Pericardial Effusion: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17351-pericardial-effusion

  Pericardial effusion is unpredictable, so you usually cant prevent it. But you can indirectly reduce your risk by avoiding circumstances that could cause it, like: […] Letting an infection go untreated for too long. […] Engaging in sports or outdoor activities that have a greater risk of injury without taking safety precautions like wearing protective equipment.

• #6 Cardiac tamponade: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/323429

  It is not possible to prevent all cases of cardiac tamponade. However, people can reduce their risk by: […] minimizing their exposure to bacterial or viral infections […] receiving treatment for medical conditions, such as lupus and hypothyroidism […] eating a well-balanced diet and exercising regularly to protect heart health […] attending regular medical checkups […] avoiding smoking […] Although it is not possible to prevent all cases of cardiac tamponade, people should be aware of their risk factors and discuss preventive methods with a doctor.

• #7 Pericardial effusion: what is it, symptoms, causes, prevention, diagnosis, tests, treatment, surgery, complications

  https://www.myupchar.com/en/disease/pericardial-effusion

  A pericardial effusion can be prevented if susceptible patients make drastic lifestyle changes, including: […] Reduce alcohol intake […] Consume a low-fat and low-salt diet […] Get adequate exercise […] Lose weight […] Treat underlying comorbidities.

• #8 Posterior pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of 25 randomised controlled trials | EuroIntervention

  https://eurointervention.pcronline.com/article/posterior-pericardiotomy-for-the-prevention-of-atrial-fibrillation-after-cardiac-surgery-a-systematic-review-and-meta-analysis-of-25-randomised-controlled-trials?s=03

  Atrial fibrillation (AF) associated with postoperative pericardial effusion is the most commonly reported adverse event after cardiac surgery. […] We aimed to determine the role of posterior pericardiotomy in preventing postoperative AF (POAF). […] As PPE has been shown to be associated with an increased incidence of postoperative AF, the drainage of pericardial blood or effusion will consequently decrease the incidence of the associated AF. […] Thus, multiple studies have proposed a method for decreasing the incidence of PPE by making an incision in the posterior pericardium and opening it to the left pleura. This eases the drainage of pericardial fluid and prevents the occurrence of PPE, thus lowering the incidence of AF. […] Multiple randomised controlled trials have tested the efficacy of performing a posterior pericardiotomy (PP) after cardiac surgery as a prophylactic measure to prevent postoperative AF (POAF).

• #9 Posterior pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of 25 randomised controlled trials | EuroIntervention

  https://eurointervention.pcronline.com/article/posterior-pericardiotomy-for-the-prevention-of-atrial-fibrillation-after-cardiac-surgery-a-systematic-review-and-meta-analysis-of-25-randomised-controlled-trials?s=03

  Our systematic review and meta-analysis of 22 studies assessing POAF found that PP helped prevent POAF in patients after CABG. […] Our findings suggest that PP can dramatically decrease pericardial effusion in patients after CABG, with both early and late pericardial effusion being much less common in the PP group compared to the control group. […] The current meta-analysis revealed that PP effectively decreases postoperative pericardiac tamponade compared to the control. […] Our results suggest that PP is a viable option for chest drainage that can lessen the likelihood of cardiac tamponade without raising the probability of pulmonary complications. […] In conclusion, this systematic review and meta-analysis found that PP effectively reduced the risk of new-onset POAF, pericardial effusion, pericardial tamponade, bleeding problems, and length of hospital stay following CABG.

• #10 Pericardial Effusion and Postoperative Atrial Fibrillation

  https://www.acc.org/latest-in-cardiology/articles/2022/10/19/14/48/pericardial-effusion-and-postoperative-atrial-fibrillation

  Posterior pericardiotomy at time of index operation may prevent pericardial effusion and thus POAF. […] A propensity-matched analysis of 697 cardiac surgery patients demonstrated that active clearance of pericardial blood products led to significantly lower rates of POAF, while another study showed that impaired pericardial drainage was associated with a significantly higher incidence of POAF. […] Prior small studies have demonstrated a reduction in POAF among patients receiving posterior pericardiotomy. […] Our group has recently performed a rigorous, adequately powered, randomized controlled trial of posterior pericardiotomy in 420 patients undergoing cardiac surgery and found that posterior pericardiotomy at time of index operation reduced the incidence of pericardial effusion (12% control group vs. 21% pericardiotomy group, respiratory rate [RR] 0.58, confidence interval [CI] 0.37-0.91) and significantly reduced the incidence of POAF (17% in intervention group, 32% in control, p 0.001).

• #11 Pericardiocentesis in cardiac tamponade: indications and practical aspects

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Pericardiocentesis-in-cardiac-tamponade-indications-and-practical-aspects

  Pericardial drainage for 24 to 72 hours is sufficient to avoid recurrence of pericardial tamponade in the majority of cases. The recurrence rate after the initial procedure is 27-55% for patients who undergo simple pericardiocentesis, and 12-24% for those who have extended drainage. […] The omission of extended catheter drainage is an important independent predictor of recurrence. It is important to empty the pericardial sac as completely as possible, leaving the catheter in place up to 72 hours or more if the fluid has a rate of accumulation greater than 30 mL in 24 hours. […] In these patients, several procedures have been suggested to prevent recurrence of tamponade. These approaches include repeat pericardiocentesis, which is probably the procedure of choice in patients with end-stage disease, intrapericardial sclerosis, systemic chemotherapy, radiation therapy, surgical intervention, or percutaneous balloon pericardiotomy.

• #12 The Use of Colchicine in Pericardial Diseases

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/04/08/22/The-Use-of-Colchicine-in-Pericardial-Diseases

  Colchicine is an ancient pharmaceutical which has shaped the way we treat inflammatory pericardial conditions. […] The European Society of Cardiology, currently endorsed by the American College of Cardiology, recommends the use of colchicine for both acute and recurrent episodes of pericarditis, and is supported by a series of trials and robust evidence. […] Currently, there is no strong evidence for the use of colchicine for pericardial effusions and constrictive pericarditis, however, evidence of pericardial inflammation should prompt the clinician to attempt a trial given the experience with colchicine in pericardial inflammatory conditions. […] Nevertheless, this would be an interesting area of future research.

• #13

  https://link.springer.com/article/10.1007/s11739-016-1496-5

  Randomized, controlled trials (RCTs) have assessed the effect of colchicine therapy in prevention of pericardial effusion (PE) and atrial fibrillation (AF). […] Colchicine therapy was not associated with a significantly lower risk of post-operative PE (RR, 0.89; 95 % CI 0.701.13; p= 0.33,I2 = 72.8 %) and AF (RR, 0.77; 95 % CI 0.521.13;p= 0.18,I 2 = 47.3 %). […] Colchicine may not significantly decrease the post-operative risk of PE and AF. However, only limited studies about patients undergoing cardiac surgery provide data about PE and AF.

• #14

  https://journals.lww.com/jcardiovascularmedicine/Fulltext/2014/12000/Controversies_in_the_prophylaxis_and_treatment_of.3.aspx?generateEpub=Article%7Cjcardiovascularmedicine:2014:12000:00003%7C10.2459/jcm.0b013e328362c5b5%7C

  Postsurgical pericardial syndromes are common complications after cardiac surgery; however, their treatment is not well established yet. […] We found 12 clinical trials (eight for the prophylaxis and four regarding treatment), testing three major agent classes: NSAIDs, corticosteroids and colchicine. […] More evidence (two wide RCT plus a meta-analysis) supports the role of colchicine for prophylaxis in adults. Prophylaxis with NSAID/corticosteroids instead failed to have significant advantage in children, whereas a few data are available for adults. […] Evidence for the treatment of postsurgical pericardial syndromes is incomplete, making it difficult to understand when to treat and which agent to employ, especially in children.

• #15

  https://link.springer.com/article/10.1007/s00246-021-02783-y

  A standard treatment for pericardial effusion without cardiac tamponade after pediatric cardiac surgery has not been established. […] In conclusion, short-term oral prednisolone treatment is effective and safe for treating pericardial effusion without cardiac tamponade after pediatric cardiac surgery. […] However, in the absence of cardiac tamponade, there is no standard treatment established for postoperative PE, as the preferred treatment differs between various institutions. […] At our institution, short-term oral prednisolone administration is the initial treatment for postoperative PE without cardiac tamponade. […] In this study, we followed our institutions treatment protocol for PE after cardiac surgery and demonstrated that the administration of oral prednisolone at a dose of 2 mg/kg/day for 3 days results in good outcomes, as indicated by the 90% response rate with no deaths or complications. […] Prophylactic steroid use for postpericardiotomy syndrome was ineffective in a previous study.

• #16 Treatment and Prophylaxis of Post-pericardiotomy Syndrome in Cardiac Surgery Patients: a Systematic Review | springermedizin.de

  https://www.springermedizin.de/treatment-and-prophylaxis-of-post-pericardiotomy-syndrome-in-car/19683168

  Post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. This systematic review aimed to investigate the efficacy of colchicine, indomethacin, and dexamethasone in the treatment and prophylaxis of PPS. […] Better outcomes have been registered when colchicine and indomethacin were administered as primary prophylactic agents in preventing PPS and PE. Further RCT studies are needed to confirm these results. […] The primary endpoint of the study was to investigate the efficacy of colchicine, dexamethasone, and indomethacin in the treatment and prevention of PPS and pleural effusion. […] The included studies also demonstrated no reduction in PE of non-inflammatory etiology. In future studies, it could be helpful that this feature is excluded from primary endpoints. Our findings showed a better outcome when colchicine and indomethacin were administered as primary prophylactic agents in reducing the risk of PPS and PE. Given their low adverse effects rates, clinical administration of colchicine and indomethacin in the preoperative setting could be considered an optimal solution to prevent PPS and PE.

• #17 Recurrent pericardial effusion after cardiac surgery: the use of colchicine after recalcitrant conventional therapy | Journal of Cardiothoracic Surgery | Full Text

  https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/1749-8090-6-96

  Pericardial effusion represents a common postoperative complication in cardiac surgery. […] Recent literature shows that colchicine therapy should be useful in the treatment of recurrent post surgical pericardial effusion. […] In the 2004 guidelines of the European Society of Cardiology suggested colchicine as a possible therapeutic choice in acute pericarditis or for the treatment and prevention of recurrent pericarditis (RP) after failure of conventional therapies. […] The same dose is given in the CORE study, but the time of administration is 6 months. […] Considering the different experiences above mentioned we give to the patient a 2 mg/die dose of colchicine for 1 month followed by 1 mg/die for a further 6 months without echocardiographyc signs of recurrent pericardial effusion. […] Recent literature shows that colchicine therapy should be usefull in treatment of recurrent post surgical pericardial effusion. […] Neverthless post surgical large studies are necessary to state definitely the use of colchicine therapy in recurrent postsurgical pericardial effusion.

• #18 Pericardial Effusion – MD Searchlight

  https://mdsearchlight.com/heart-health/pericardial-effusion/

  Doctors need to always be alert for the chance of a severe build-up of fluid around the heart known as a large pericardial effusion thats on the verge of causing life-threatening pressure on the heart, known as tamponade. This can happen in patients even if theyre not showing any symptoms, or if their initial health concerns seemed unrelated. Patients who have this major fluid build-up around their heart can rapidly worsen, no matter when they first started showing symptoms. So, its especially crucial for doctors to watch closely for any major fluid changes in patients.

• #19 How Can Pericardial Effusion Be Diagnosed And Managed To Prevent Heart Enlargement? – Klarity Health Library

  https://my.klarity.health/how-can-pericardial-effusion-be-diagnosed-and-managed-to-prevent-heart-enlargement/

  Pericardial effusion, if left untreated, can lead to chronic pressure on the heart, resulting in enlargement, also known as cardiomegaly. Preventing heart enlargement involves prompt and appropriate management of pericardial effusion. Here are some preventive measures: […] Patients with known risk factors, such as autoimmune diseases or a history of pericardial effusion, should undergo regular cardiac evaluations. […] Addressing symptoms and seeking medical care at the first sign of discomfort can help prevent effusion from progressing. […] Following the prescribed medication regimen, attending follow-up appointments, and completing diagnostic tests as recommended are crucial to managing and preventing recurrence. […] If diagnosed and treated promptly, pericardial effusion can be a manageable condition. By understanding the causes, recognizing the symptoms, and utilizing appropriate diagnostic tools, individuals and healthcare providers can prevent the progression of heart enlargement. Early intervention, coupled with preventive care and monitoring, helps maintain heart health and mitigates the risks associated with pericardial effusion.

• #20 Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-020-02467-w

  Acute pericarditis, pericardial effusion, and cardiac tamponade should be considered in patients presenting with chest pain who have suspected or proven coronavirus disease 2019 (COVID-19). Clinicians should broaden their differential diagnoses when evaluating these patients and use ultrasound early to help guide the diagnosis. Early diagnosis and treatment will likely prevent complications associated with acute pericarditis. […] In addition to a focus on other symptoms, prevention is important. The basic reproductive number (R0) is higher than previously thought. This means that COVID-19 is significant and demands focused nonpharmacologic prevention strategies such as wearing masks, social distancing, quarantining, isolation, and diligent hand hygiene.

• #21 Pericarditis: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17353-pericarditis

  Although you cant prevent acute pericarditis, getting quick treatment and sticking with it can help you reduce your risk of getting it again. […] Continuing with your treatment can help you prevent pericarditis from happening again. That’s why it’s important to keep taking prescribed medicines and go to all of your follow-up appointments.

• #22 Pericardial Effusion: Causes, Symptoms, Treatment and Cost

  https://www.lybrate.com/topic/pericardial-effusion

  Avoid the risk factors associated with Pericardial Effusion, such as certain infections and conditions that affect the heart. […] Maintain a healthy lifestyle by engaging in frequent exercise and eating a food that is both balanced and nutritious. […] Follow your doctors instructions for any medications prescribed to treat or prevent Pericardial Effusion. […] Closely monitor your condition, and make sure to attend all of the follow-up appointments that your healthcare practitioner schedules for you.

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