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Abstract OBJECTIVESPericardial effusion is a common complication after cardiac surgery, both isolated and in post-pericardiotomy syndrome (PPS), a condition in which pleuropericardial damage triggers both a local and a systemic inflammatory/immune response. The goal of this review was to present a complete picture of PPS and pericardial complications after cardiac surgery, highlighting available evidence and gaps in knowledge.METHODSA literature review was performed that included relevant prospective and retrospective studies on the subject.RESULTSPPS occurs frequently and is associated with elevated morbidity and significantly increased hospital stays and costs. Nevertheless, PPS is often underestimated in clinical practice, and knowledge of its pathogenesis and epidemiology is limited. Several anti-inflammatory drugs have been investigated for treatment but with conflicting evidence. Colchicine demonstrated encouraging results for prevention.CONCLUSIONSWider adoption of standardized diagnostic criteria to correctly define PPS and start early treatment is needed. Larger studies are necessary to better identify high-risk patients who might benefit from preventive strategies.

Postpericardiotomy syndrome (PCTS) is one of the most frequent cardiac surgery complications seen in 9-65% of patients. Despite its widespread occurrence, the mechanisms of the development of PCTS are still understudied. drug. The use of colchicine in cardiac surgery patients is of particular interest. Due to the ability of this drug the colchicine mechanisms of action are able to inhibit the mobilization of the NLRP3 inflammasome assembly, to suppress the activation of caspase-1. As a result, it can prevent the release of proinflammatory cytokines, namely IL-1β and IL-18. There are conflicting data on the effect of colchicine on the PCTS progression within the systemic inflammatory response after cardiac surgery. In this regard, it was important to study the dynamics of serum levels of IL-6, IL-10, IL-1β, and TNFα in patients before coronary artery bypass grafting (T1), 6 hours (T2), and 10 days (T3) after surgery, and to evaluate the effect of colchicine on the development of PCTS. The results of our research showed a significant increase of IL-10 in both groups 6 hours after surgery. However, on the 10th day, the increase in the level of IL-10, compared with the initial values, was higher in the 1stgroup – 2 times, compared with the 2nd group. In both groups, showed significant increase in serum concentration of IL-6 after 6 h surgery, with a subsequent decrease in the expression at the stage of T3, while the IL-6 levels in the 2ndgroup was statistically notably higher than T1. The incidence of pleurisy was lower in the group of patients taking colchicine. Only in the 1st group IL-6 levels were directly associated with IL-10. In patients with pleurisy, the level of released IL-10 and TNFα was significantly higher in the 2nd group. There were no significant intergroup differences in serum levels of IL-1β and TNFα, as well as significant changes in IL-1β between the stages of observation. Analysis of TNFα expression revealed significant differences in TNFα content in the 1stgroup between the T1-T3 and T2-T3 stages. In both groups, multiple positive associations were found between the studied indicators. Thus, data were obtained indicating the antiinflammatory effect of colchicine in cardiac surgery patients. This was clinically expressed in a tendency to a lower incidence of pleurisy, and was accompanied by increased expression of IL-10, which has an antiinflammatory and immunomodulatory effect against the background of the drug in the postoperative period.

Aim To compare features of the disease course and the effectiveness of nonsteroidal anti-inflammatory drug (NSAID) treatment of postpericardiotomy syndrome (PPS) in patients after coronary bypass (CB) surgery who were treated with antiplatelet drugs and in patients after surgical correction of heart valve disease (CHVD) who received the anticoagulant warfarin for prevention of thrombotic complications. Material and methods This study included 89 patients of whom 53 patients had underwent CB and 36 patients had underwent CHVD. At 15 [13; 15] days after surgery, the severity of inflammatory response, the state of coagulation hemostasis, and hematocrit were studied. At 5 days after the first test, blood count and measurement of C-reactive protein were repeated. Echocardiography was used to determine the presence and volume of pleural effusion. For prevention of thrombotic complications, antiplatelet drugs were administered after CB and warfarin was administered after CHVD. PPS was detected in 35 (66 %) patients after CB and 18 (50 %) patients after CHVD. The ibuprofen treatment (600 mg twice a day) was administered to all patients with PPS. If positive changes in inflammatory markers were absent during the NSAID treatment, ibuprofen was replaced with prednisolone 0.5 mg/kg body weight with subsequent laboratory and instrumental monitoring. Results Patients after CHVD treated with warfarin had higher values of international normalized ratio (INR) and activated partial thromboplastin time (aPPT) and lower values of prothrombin index (PTI), fibrinogen (pConclusion Hypocoagulation observed in patients after CHVD due to the anticoagulant treatment with warfarin was associated with more severe course of PPS and lower effectiveness of the NSAID treatment compared to patients after CB. This results in more frequent replacement of NSAIDs with glucocorticoids in the treatment of patients after CHVD.

Aortic valve replacement has long been the standard of care for many aortic valve diseases. Neo sinus reconstruction and aortic valve reconstruction with native pericardium, known as the Ozaki procedure, is a relatively new technique with early studies showing good mid-term durability and hemodynamics without the need for life-long anticoagulation. We present the case of a 56-year-old male presenting with aortic valve endocarditis and severe aortic insufficiency who underwent successful aortic valve reconstruction via the Ozaki procedure complicated by postpericardiotomy syndrome and cardiac tamponade. Although the Ozaki procedure is a promising alternative to conventional aortic valve replacement, further study is needed to determine long-term re-operation rates, stability and mortality.

AimTo analyze cases of idiopathic recurrent pericarditis (IRP) in the structure of pericardial diseases of various origins from patient visits to the Multidisciplinary Federal Center.Material and methodsA retrospective analysis of case records was performed for patients admitted to the V.A. Almazov National Medical Research Center from January 1, 2015 through January 1, 2020 for pericardial effusion of different etiologies.ResultsFor the study period, 4 981 new cases of pericardial damage of different etiologies were found. Among these cases, postpericardiotomy syndrome accounted for 4 360 cases and pericarditis for 621 cases. IRP was detected in 34 cases, which amounted to 5.4 %. Based on the study data, the estimated IRP prevalence in the Russian Federation can be 1.1 cases per 100 thousand population.ConclusionIRP should be regarded as a new autoinflammatory disease, the prevalence of which borders on that of adult Still disease and should be addressed within the concept of orphan diseases. Current knowledge of the pathogenesis and data from recent studies demonstrated a great importance of interleukin-1 blockade as a leading mechanism for achieving remission. This has justified conduction of a randomized clinical study at the Center.

Postpericardiotomy syndrome (PCTS) develops after cardiosurgical operations as part of the non-specific systemic inflammatory responses syndrome of the body (SIRS) and manifests signs of general intoxication and symptoms of involvement in the autoimmune inflammatory process of pulmonary pleurae and/or pericardial layer to form efflux in the pleural and/or pericardial cavities. PCTS is not a rare pathological condition and often accompanies heart surgeries, especially those which are carried out under cardiopulmonary bypass. However, it can occur in the guise of lung and pleura diseases, cardiac decompensation and other complications of cardiological diseases and cardiosurgical interventions. In the light of the specificity of the therapy of this syndrome, its correct and timely diagnosis is intended to alleviate the already unsatisfactory condition of the patient who has undergone heart surgery and his postoperative prognosis. Although this pathology was described in the middle of the last century, its methods of treatment are still under discussion, in particular the effectiveness of glucocorticosteroids and colchicine is compared and the use of the latter for the prevention of PCTS is considered. This paper presents the case history of PCTS tolerant to hormone therapy and managed with colchicine.

BACKGROUND: According to different studies, diabetes mellitus type 2 (DM2) is associated with higher mortality after undergoing coronary artery bypass grafting (CABG). Perioperative hyperglycaemia, even in non-DM2 patients, is associated with adverse outcomes after CABG. Thus, successful perioperative blood glucose control (BGC) is mandatory to reduce the risk of death and postoperative complications. Nowadays, the most effective method for BGC in the operating room is still unknown. AIMS: To assess the continuous glucose monitoring (CGM) efficacy in association with insulin pump therapy in patients with coronary artery disease (CAD) and DM2 undergoing CABG in intra- and early postoperative periods. METHODS: The study involved 97 patients undergoing isolated CABG. Patients were divided into two groups: 48 patients with DM2 and 49 patients without DM2. In both groups of patients, we used CGM in intra- and early postoperative periods (72 hours). In some patients with DM2, CGM was associated with insulin pump therapy (MiniMed Paradigm Veo 554/754) to successfully control postoperative glucose level. Besides commonly used tests (such as HbA1C and lipid profile), we analysed high sensitive C-reactive protein (hs-CRP) levels before surgery, and then at 1 hour, 12 hours and 7 days after CABG in order to estimate their prognostic value. RESULTS: During the 48 hours after CABG, there was a trend towards having higher glucose levels in both groups of patients with and without DM2 according to CGM. In patients with DM2, the glucose level was significantly increased (р0,05). Insulin pump therapy resulted in glycemic control improvement in early follow-up (72 hours). Moreover, there were no hypoglycaemic episodes in patients on insulin pump therapy and also in patients prescribed bolus insulin therapy. We revealed the trend towards lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p=0,1). Hs-CRP level was lower in patients with DM2 who were on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р0,05). This most likely confirms that insulin pump therapy decreases systemic inflammatory response. CONCLUSIONS: Thus, we demonstrated the CGM feasibility, safety and efficacy in association with insulin pump therapy in patients with DM2 undergoing CABG.

The postpericardiotomy syndrome (PPS) is an important cause of morbidity and mortality following heart operation. This systematic review reviewed the literature regarding PPS. It was found to occur on day 18.3 ±15.9 after cardiac operations, most often after coronary artery bypass grafting, and mitral valve replacement. The most common symptoms were new/worsening pericardial effusions, pleuritic chest pain, and fever. The inflammation markers, such as C-reactive protein and erythrocyte sedimentation rate, were found to increase significantly in each patient who had these parameters examined. The subjects were managed conservatively in 472 (83.5%) patients, by surgical pericardial drainage in 85 (15.0%) patients, by thora-/pericardio-centesis in 3 (0.5%) patients, and were under surveillance without being treated in 5 (0.9%) patients. Conservative treatment was likely to be associated with a higher recovery rate. Surgical trauma and cardiopulmonary bypass trigger the systemic inflammatory response, which results in antiheart autoantigen release, and the deposited immune complex could be found in the pericardial, pleural, and lung tissues, thereby provoking the occurrence of PPS. Therapeutic options for the refractory cases are long-term oral corticoids or pericardiectomy. Surgical intervention was warranted in 2.6% of the cases due to cardiac tamponade.

Objective: to study the functional characteristics of innate immunity in the formation of postpericardial syndrome (PPS) in patients undergoing coronary artery bypass graft ing (CABG).Materials and methods: the study involved 60 people, 40 of them made up the main group of patients with coronary artery disease, which retrospectively aft er 1 month of observation was divided into 2 groups. Group I CABG and PPS, group II CABG without PPS. The control group consisted of 20 patients without IHD. Before surgery, aft er 5, 14 days and 1 month, the expression of toll-like receptors (TLRs) 2, 4, 9, the content of CD16+ and Granzyme B lymphocytes, the HCT test and serum α-defensin were evaluated in blood cells. Statistical analysis of the results of the study was carried out using the program Statistica 12.0 (StatSoft , USA). The difference in mean values between groups was evaluated by the Mann-Whitney test. Statistical signifi cance was considered signifi cant at p ≤ 0.05.Results: when comparing the initial indices of the main groups and the control group, an increase in the expression of TLRs 2, 4, 9 was revealed. An increase in the content of CD16+, as well as an increase in the cytotoxic activity of natural killers and an increase in the production of α-defensin.Conclusions: on the basis of the study, activation of the cellular link of innate immunity, an increase in the cytotoxic potential of natural killers and a signifi cantly high level of α-defensin both before and aft er CABG were revealed, which can play an important role in the development of PPS.

Aim. To assess the predictive value of polymorphic variants analyzing of interleukin-6 (IL-6) gene in patients with postpericardiotomy syndrome (PPS) during open-heart surgery.Material and methods. The study included 200 patients. All patients were analyzed for acute phase parameters in serum, effusion fluid and region of IL-6 gene promoter sequence.Results. When analyzing the effusion fluid, in 15% of patients with early PPS, in accordance with the Light RW criteria, transudate was detected. Application of the Roth BJ criteria increased this proportion to 32%. An increase in the level of C-reactive protein (CRP), procalcitonin, and adenosine deaminase (ADA) activity indicated a systemic inflammatory response. The viral genome of cardiotropic viruses was detected in the effusion fluid in 10-12% of patients with PPS. Scanning mutations in the IL-6 500 bp region revealed one polymorphism of -174G>C. The frequency ofPPS in patients with different genotypes (-174GC, -174GG and -174CC) did not significantly differ. An association of the -174GG genotype of the IL-6 gene with a high risk of developing systemic inflammation in open-heart surgery and more frequent postoperative infectious complications has been established. In addition, the -174GG genotype was more often detected in patients with late PPS (p=0,017). There was nocorrelation between the occurrence of genotypes, as well as the distribution of IL-6 gene and coronary obstruction index. However, carriage of the G allele was more often detected in patients with injury of left main coronary artery.Conclusion. The presence of the -174GG genotype of the IL-6 gene and cardiotropic viruses contribute to the systemic inflammation during cardiosurgical interventions in extracorporeal circulation, but do not have predictive value for the PPS development.

To study the role of paraoxonase, myeloperoxidase, arginase, asymmetric dimethylarginine, and nitric oxide in the mechanisms of the pathogenesis of postpericardiotomy syndrome (PPCS), 76 patients with ischemic heart disease (IHD) who underwent coronary artery bypass grafting were examined. Patients were divided into two groups: Group 1, IHD patients who were not diagnosed with PPCS as a result of clinical studies, and Group 2, IHD patients who were diagnosed with PPCS. The results indicate that the postoperative period after coronary artery bypass grafting is associated with the inhibition of paraoxonase, the activation of myeloperoxidase, enhanced arginase activity, increased nitrite/nitrate and asymmetric dimethylarginine levels; it may also be accompanied by the development of endothelial dysfunction and increased systemic inflammatory response. In the present work, inverse correlations were found between the paraoxonase aryl esterase activity and myeloperoxidase activity in plasma, as well as the paraoxonase aryl esterase activity in blood plasma and arginase activity in erythrocytes in patients of both groups. Tests to predict the development of postpericardiotomy syndrome were developed based on the ratio of activity of the studied enzymes.

A standard treatment for pericardial effusion without cardiac tamponade after pediatric cardiac surgery has not been established. We evaluated the efficacy of short-term oral prednisolone administration, which is the initial treatment for postoperative pericardial effusion without cardiac tamponade at our institution. Between October 2008 and March 2020, 1429 pediatric cardiac surgeries were performed at our institution. 91 patients required postoperative treatment for pericardial effusion. 81 were treated with short-term oral prednisolone. Pericardial effusion was evaluated using serial echocardiography during diastole. Pericardial drainage was performed for patients with circumferential pericardial effusion with a maximum diameter of ≥ 10 mm or signs of cardiac tamponade. Short-term oral prednisolone treatment was administered to patients with circumferential pericardial effusion with a maximum diameter of

Post-pericardiotomy syndrome (PPS) is a common inflammatory process following cardiac surgery, in which the pericardial space was opened. Pericardial effusion (PE) is a common manifestation in PPS; however, coronary artery dilation is not associated with PPS. Inflammatory vasculitis in children are known to cause coronary dilation, in conditions such as in Kawasaki Disease (KD). We report a patient with PPS and concomitant coronary dilation by transthoracic echocardiography (TTE) following repair of her ventricular septal defect (VSD).

Funding Acknowledgements Type of funding sources: None. Introduction Postpericardiotomy syndrome (PPS) and atrial fibrillation (AF) are complications occurred in one-third of cardiac surgery patients that increase morbidity and mortality. Colchicine is an anti-inflammatory drug for treating acute pericarditis and pericardial effusion. Previous studies suggested that colchicine also may prevent PPS and AF after cardiac surgery although the results were still inconsistent. Purpose This study intends to determine the efficacy of colchicine for preventing PPS and AF in post-cardiac surgery patients. Methods We conducted comprehensive literature searching in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library, to include all relevant studies until November 2020. We included all randomized controlled trials (RCTs) that access the incidence of PPS and AF after cardiac surgery in patients who received colchicine before cardiac surgery compared with placebo. We use revised Cochrane risk-of-bias tool (RoB 2) for accessing the bias risk of included studies. We performed analysis to provide pooled risk ratio (RR) with 95% confidence interval (CI) using fixed-effect heterogeneity test. Results We included 9 RCTs with total of 2,372 participants met our inclusion criteria. The administration of colchicine before cardiac surgery decreases the incidence of PPS significantly (pooled RR = 0.55, 95% CI 0.43 – 0.71, p Conclusions Colchicine showed potential benefits for preventing PPS and AF after cardiac surgery. However, further trials are needed to establish the efficacies.

Objectives Postpericardiotomy syndrome (PPS) is a relatively common complication after cardiac surgery. However, long-term follow-up data on the adverse events and mortality of PPS patients requiring invasive interventions are scarce. Methods We sought to assess the occurrence of mortality, new-onset atrial fibrillation (AF), cerebrovascular events, and major bleeds in PPS patients requiring medical attention in a combination database of 671 patients who underwent isolated surgical aortic valve replacement with a bioprosthesis (n = 361) or mechanical prosthesis (n = 310) between 2002 and 2014 (Cardiovascular Research Consortium—A Prospective Project to Identify Biomarkers of Morbidity and Mortality in Cardiovascular Interventional Patients [CAREBANK] 2016-2018). PPS was defined as moderate if it resulted in delayed hospital discharge, readmission, or medical therapy because of the symptoms; and severe if it required interventions for the evacuation of pleural or pericardial effusion. Results The overall incidence of PPS was 11.2%. Median time to diagnosis was 16 (interquartile range, 11-36) days. Severe PPS was diagnosed in 3.6% of patients. Severe PPS seemed to be associated with higher mortality (hazard ratio, 2.01; 95% confidence interval, 1.03-3.91; P = .040). Moderate or severe PPS increased the risk of new-onset AF during the early postoperative period (hazard ratio, 1.72; 95% confidence interval, 1.12-2.63; P = .012). No significant associations were found between PPS and cerebrovascular events or major bleeds during the follow-up. Conclusions Patients with PPS requiring invasive interventions are at increased risk for mortality unlike those with mild to moderate forms of the disease. PPS requiring medical attention is associated with a higher AF rate during the early postoperative period but has no significant effect on the occurrence of major stroke, stroke or transient ischemic attack, or major bleeds during long-term follow-up.

Background Pericarditis in pregnancy is uncommon. Treatment options, including NSAIDs and long term gluco-corticosteroids (CS) have extensive side-effects, while data on the use of Colchicine in pregnant women who suffer from pericarditis is limited. Objective To evaluate the management and outcome of active pericarditis during pregnancy in both acute (AP) and recurrent pericarditis (RP) patients. Methods and results Twelve pregnant women (14 pregnancies) with active pericarditis were followed prospectively in our cardiology-pregnancy clinic; 6 with AP and 8 with RP. Etiology: 11 idiopathic, 2 post-pericardiotomy syndrome and 1 Q fever. Maternal age on presentation was 27±4y vs. 33±3y in RP vs AP respectively. Average gestational age upon diagnosis was lower in RP than in AP (18 weeks, range 6–30 vs 26 weeks, range 5–35). In the RP group, 7/8 women (87%) were treated with CS compared with 2/6 women (33%) in the AP group; 3 women in RP group (37%) failed to respond to subsequent treatment with azathioprine and 1 patient was treated successfully with Anakinra. Colchicine was prescribed in 13/14 (93%) of pregnancies, average colchicine exposure during pregnancy was 25±15 weeks. Recurrence during pregnancy: 6/8 (75%) of RP; 2/6 (33%) of the AP, all of them on CS. All pregnancies culminated in a live birth with a mean gestational age on delivery of 37±1.4 weeks. Average birthweight was 3267±507 grams. There were no fetal anomalies or developmental delays after a mean follow-up of 2.7 years. All newborns and maternal outcomes were normal. On long term follow-up after delivery RP patients treated with colchicine developed less recurrences. Conclusion Active pericarditis is associated with a high recurrence rate during pregnancy despite treatment with CS. Colchicine use in pregnant women with active pericarditis appears to be safe. Funding Acknowledgement Type of funding source: None

Post-cardiac injury syndrome (PCIS) is presumed to be an immune-mediated process. It affects the pericardium and, to a lesser extent, the epicardium, myocardium, and pleura. It has been rarely reported following pacemaker insertion with an estimated incidence of 1% to 2%. We present the case of a 62-year-old female who developed PCIS 8 weeks following pacemaker insertion. She presented with impending cardiac tamponade requiring pericardiocentesis; recurrent pleural effusions subsequently complicated her condition. The pleural effusion recurred despite trials of steroids, eventually requiring talc pleurodesis. This case highlights the need to consider PCIS as a possible etiology of recurrent pleural effusion following pacemaker insertion.

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 PPS – defined as PPS requiring invasive interventions – was 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.

Purpose Extracorporeal membrane oxygenation (ECMO) is increasingly used with various indications. The clinical course can be complicated by an abdominal compartment syndrome (ACS). A decompressive laparotomy (DL) can be an option. Materials and methods Between 2014 and 2016 175 patients underwent ECMO support. Indications, demographic data, comorbidities, morbidity, mortality and length of stay were analyzed. Results Indications for ECMO were acute respiratory distress syndrome (n = 65), postpericardiotomy syndrome (n = 37), myocardial infarction (n = 26), extracorporeal cardiopulmonary resuscitation (n = 11), and others (n = 36). ECMO support was performed as veno-venous (VV, n = 91) or veno-arterial (VA, n = 84). Eleven patients developed ACS (VV-ECMO: n = 4; VA-ECMO: n = 7) and underwent DL. Three patients survived to hospital discharge. Risk factors were age (57 vs. 60.5 years, P = 0.032), a Charlson comorbidity index >1 (CCI, P = 0.004), a Simplified Acute Physiology Score (SAPS II) ≥ 42 at admission to ICU (P = 0.013) and ≥44 at the beginning of ECMO support (P = 0.004). When an ACS/DL occurred, mortality did not differ (DL: n = 11; 73% vs. no DL: n = 164; 65%; P = 0.749). Multivarate analysis revealed CCI and SAPS as independent predictors for mortality. Conclusions Approximately 10% of patients undergoing VA-ECMO support developed an ACS. If DL is undertaken, SAPS II scores can be used as predictive factor for mortality.

Post-pericardiotomy syndrome (PPS) is an inflammatory process involving the pleura, pericardium, or both and occurs after cardiothoracic surgery. Surgical atrial septal defect (ASD) closure is associated with higher incidence of PPS post-operatively as compared to other operations. Reported incidence of PPS varies from 1 to 40%. NSAIDs are often used to treat PPS and in our center, some practitioners have prescribed ibuprofen prophylactically. This study sought to investigate the impact of prophylactic treatment with ibuprofen on the development and severity of PPS following surgical ASD closure, with particular attention to secundum-type ASDs. We retrospectively reviewed clinical and operative data of all surgical ASD repairs in our center from 1/2007 to 7/2017. ASDs were grouped by subtype. PPS was considered positive if the primary cardiologist diagnosed and documented clinical signs of PPS on post-operative outpatient follow-up. Records were reviewed to confirm documented diagnosis of PPS. A total of 245 cases were reviewed with 207 having sufficient data. Median age was 2 years (range 4 months-27 years), female 57%. Overall incidence of PPS was 10%. There was no difference in incidence of PPS in those prescribed ibuprofen as compared to those who were not. This was true for both the entire cohort and the subgroup analysis (P = 1.0). Four patients overall required pericardiocentesis, none of whom received prophylactic ibuprofen. Prophylactic ibuprofen prescription following surgical ASD repair did not reduce the rate of PPS in our cohort.

An examination of a group of 76 CAD patients after coronary artery bypass grafting was performed with the goal to investigate the role of proinflammatory cytokines and enzymes participating in redox regulation in the mechanisms of development of systemic inflammation response and pathogenesis of postpericardiotomy syndrome (PPS). The patients were divided into two groups: the first group was CAD patients that were not diagnosed with PPS based on clinical examination, and the second group was CAD patients diagnosed with PPS. The enhancements of IL-6 and IL-8 production, as well as imbalance in the functions of peroxiredoxin-1 and glutathione peroxidase, was observed in the blood plasma of the patients from both groups. These changes were observed at earlier stages in the patients with PPS, and they were more substantial. The results of this work confirmed the high efficiency of the investigated indicators for prevention and monitoring of the PPS development.

Patients with congenital heart disease (CHD) are surviving longer thanks to improved surgical techniques and increasing knowledge of natural history. Pleural effusions continue to be a complication that affect many surgical patients and are associated with increased morbidity, many times requiring readmission and additional invasive procedures. The risks for development of pleural effusion after hospital discharge are ill-defined, which leads to uncertainty related to strategies for prevention. Our primary objective was to determine, in patients with CHD requiring cardiopulmonary bypass, the prevalence of post-surgical pleural effusions leading to readmission. The secondary objective was to identify risk factors associated with post-surgical pleural effusions requiring readmission. We identified 4417 citations; 10 full-text articles were included in the final review. Of the included studies, eight focused on single-ventricle palliation, one looked at Tetralogy of Fallot patients, and another on pleural effusion in the setting of post-pericardiotomy syndrome. Using a random-effect model, the overall prevalence of pleural effusion requiring readmission was 10.2% (95% CI 4.6; 17.6). Heterogeneity was high (I2 = 91%). In a subpopulation of patients after single-ventricle palliation, the prevalence was 13.0% (95% CI 6.0;21.0), whereas it was 3.0% (95% CI 0.4;6.75) in patients mostly with biventricular physiology. We were unable to accurately assess risk factors. A better understanding of this complication with a focus on single-ventricle physiology will allow for improved risk stratification, family counseling, and earlier recognition of pleural effusion in this patient population.

Colchicine has been used as anti-inflammatory agent in pericardial effusion (PE). We sought to perform a meta-analysis of randomized trials assessing the efficacy and safety of colchicine in patients with pericarditis or postpericardiotomy syndrome (PPS).In the systematic literature search following the PRISMA statement, 10 prospective randomized controlled studies with 1981 patients with an average follow-up duration of 13.6 months were identified.Colchicine reduced the recurrence rate of pericarditis in patients with acute and recurrent pericarditis and reduced the incidence of PPS (RR: 0.57, 95% CI: 0.44-0.74). Additionally, the rate of rehospitalizations as well as the symptom duration after 72 h was significantly decreased in pericarditis (RR 0.33; 95% CI 0.18-0.60; and RR 0.43; 95% CI 0.34-0.54; respectively), but not in PPS. Treatment with colchicine was associated with significantly higher adverse event (AE) rates (RR 1.42; 95% CI 1.05-1.92), with gastrointestinal intolerance being the leading AE. The reported number needed to treat (NNT) for the prevention of recurrent pericarditis ranged between 3 and 5. The reported NNT for PPS prevention was 10, and the number needed to harm (NNH) was 12, respectively. Late colchicine administration 7 days after heart surgery did not reduce postoperative PE.Our meta-analysis confirms that colchicine is efficacious and safe for prevention of recurrent pericarditis and PPS, while it reduces rehospitalizations and symptom duration in pericarditis. The clinical use of colchicine for the setting of PPS and postoperative PE after heart surgery should be investigated in further multicenter RCT.

Introduction In this study, we identify the frequency of pseudopolyps (PPs) with normal histology and their association to surrounding tissue. Methods Patients were enrolled in a study identifying endoscopic characteristics of PPs (n = 29) or were collected as part of our IBD biobank (n = 16). Statistical analysis included Stata v.15.0. chi-square and Student t-test. Results A total of 45 patients with 117 PP biopsies were identified. More patients with healed PP were in endoscopic remission compared with those with inflammatory PP (82.6% vs 17.4%, respectively). Conclusion This is the first study to find mucosal healing of PPs and its association with deep remission., “Healed” pseudopolyps, which are projecting masses of scar tissue developed during the healing phase of IBD, were detected in patients with healed mucosa in the colon (endoscopic remission) more often than “inflammatory” pseudopolyps, which reflect active inflammation in the colon.

Background Colchicine has been used as anti-inflammatory agent in pericardial effusion (PE). We sought to perform a meta-analysis of randomized trials assessing the efficacy and safety of colchicine in patients with pericarditis or postpericardiotomy syndrome (PPS). Methods In the systematic literature search following the PRISMA statement, 10 prospective randomized controlled studies with 1981 patients with an average follow-up duration of 13.6 months were identified. Results Colchicine reduced the recurrence rate of pericarditis in patients with acute and recurrent pericarditis and reduced the incidence of PPS (RR: 0.57, 95% CI: 0.44–0.74). Additionally, the rate of rehospitalizations as well as the symptom duration after 72 h was significantly decreased in pericarditis (RR 0.33; 95% CI 0.18–0.60; and RR 0.43; 95% CI 0.34–0.54; respectively), but not in PPS. Treatment with colchicine was associated with significantly higher adverse event (AE) rates (RR 1.42; 95% CI 1.05–1.92), with gastrointestinal intolerance being the leading AE. The reported number needed to treat (NNT) for the prevention of recurrent pericarditis ranged between 3 and 5. The reported NNT for PPS prevention was 10, and the number needed to harm (NNH) was 12, respectively. Late colchicine administration ≥ 7 days after heart surgery did not reduce postoperative PE. Conclusions Our meta-analysis confirms that colchicine is efficacious and safe for prevention of recurrent pericarditis and PPS, while it reduces rehospitalizations and symptom duration in pericarditis. The clinical use of colchicine for the setting of PPS and postoperative PE after heart surgery should be investigated in further multicenter RCT.

Hyperglycemia is associated with adverse outcomes after coronary artery bypass grafting (CABG). While there is a consensus that blood glucose control may benefit patients undergoing CABG, the role of biomarkers, optimal method, and duration of such monitoring are still unclear. The aim of this study is to define the efficacy of a continuous glucose monitoring system (CGMS) and link it to pro-inflammatory biomarkers while on insulin pump therapy in diabetic patients undergoing CABG. We prospectively assessed CGMS for 72 h in 105 patients including 52 diabetics undergoing isolated CABG. In diabetics, CGMS was connected to an insulin pump for precise glucose control. On top of conventional biomarkers (HbA1C, lipid profile), high sensitive C-reactive protein (hs-CRP), Regulated upon Activation Normal T cell Expressed and presumably Secreted (RANTES), and leptin levels were collected before surgery, 1 h, 12 h, 7 days, and at 1 year after CABG. Overall, CGMS revealed high glucose independently from underlying diabetes during first 48 h following CABG but was higher (р &lt, 0.05) in diabetics. The insulin pump improved glycemic control over early follow-up (72 h) post-CABG. There were no hypoglycemic episodes in patients on insulin pump therapy and those receiving bolus insulin therapy. We revealed a lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p = 0.03). Hs-CRP and RANTES levels were lower in patients with T2DM on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р &lt, 0.05). It is most likely due to the fact that insulin pump therapy decreases systemic inflammatory response. Further controlled trials should assess whether CGMS improves outcomes after cardiac surgery.

Objective: We aimed to define whether timing and multiple surgeries have an impact on development of postpericardiotomy syndrome (PPS) and its complications. Methods: We retrospectively analyzed clinical and operative data of 40 patients with signs of PPS after cardiac surgery. Among them, 9 patients had signs of effusion (E) only and 31 patients had adhesive/ constrictive/constrictive-effusive (C) pericardial involvement. Results: Patients in E only group had significantly larger E size (p=0.03), higher white blood cell count (p=0.014) and tendency to higher sedimentation rate (SR) as compared to C group. We found significantly longer period of hospital stay (p=0.042), higher number of redo surgeries (1.33(0.88) vs 0.67(0.50), p=0.008) and longer time past since latest surgery (102.91(97.49) vs. 0.14(0.38) months, p

Introduction: Pericarditis is an inflammation of the pericardium. It may be infectious or secondary to a systemic disease. The aim of this study was to analyze the clinical findings, course, treatment and follow-up of children diagnosed with pericarditis at our center. Methods: We performed a retrospective analysis of all children admitted to our pediatric cardiology unit with pericarditis between 2003 and 2015. Patient characteristics were summarized using frequencies and percentages for categorical variables and medians with percentiles for continuous variables. Results: Fifty patients were analyzed (40 male, 10 female) with a median age of 14 years. The most common diagnosis was acute pericarditis (80%). Thirty-five patients (70%) presented with chest pain and 26% reported fever. Cardiomegaly was identified on chest X-ray in 11 patients (22%), 30 patients (60%) had an abnormal ECG and 44 patients (80%) had alterations on the transthoracic echocardiogram. In 17 cases (34%) there was myocardial involvement. Forty-eight percent of patients presented with infectious pericarditis and the pathologic agent was identified in half of them. Postpericardiotomy syndrome was diagnosed in five cases. The first-line therapy was aspirin in 50% of cases. Pericardiocentesis was performed in 12 patients. The median length of stay was nine days. There was symptom recurrence in seven children. Conclusions: In this study, acute infectious pericarditis was the most common presentation and about one third of patients also had myocarditis. The symptom recurrence rate was not negligible and is probably related to the type of therapy employed. Resumo: Introdução e objetivo: A pericardite é uma doença inflamatória que ocorre de forma isolada ou em contexto de doença sistémica. Neste trabalho pretende-se caracterizar a forma de apresentação, orientação diagnóstica e terapêutica, e o seguimento dos doentes internados com este diagnóstico. Métodos: Análise descritiva retrospetiva de doentes internados num único Serviço de Cardiologia Pediátrica, com o diagnóstico de pericardite, entre 2003 e 2015. As características da população são expressas em frequência e percentagem nas variáveis categóricas e em mediana e percentis nas variáveis contínuas. Resultados: Identificaram-se cinquenta doentes, sendo predominante o sexo masculino (80%) e com uma mediana de idades de 14 anos. A pericardite aguda foi o diagnóstico mais frequente (80%). Na avaliação inicial, 35 doentes (70%) apresentaram toracalgia e 13 (26%) relataram febre. Em 11 doentes (22%) verificou-se cardiomegália na radiografia do tórax, em 30 (60%) registaram-se alterações do ECG e em 44 (88%) observaram-se alterações no ecocardiograma transtorácico. Em 17 casos (34%) foi diagnosticada miopericardite. A etiologia mais comum foi a infeciosa (48%), com agente identificado em metade dos casos. Houve cinco casos de Síndrome Pós-Pericardiotomia. A primeira linha terapêutica foi o ácido acetilsalicílico (50%). Em 12 doentes (24%) realizou-se pericardiocentese. A duração do internamento teve uma mediana de nove dias. Em sete crianças (14%) houve recorrência dos sintomas após o episódio inaugural. Conclusões: Nesta casuística verificou-se que a causa mais frequente de pericardite foi a infeciosa. Em um terço dos doentes decorreu com componente de miocardite e a recidiva não é desprezível com a terapêutica clássica. Keywords: Pericarditis, Pericardium, Child, Adolescent, Anti-inflammatory agents, Palavras-chave: Pericardite, Pericárdio, Criança, Adolescente, Anti-inflamatórios

SUMMARY Postpericardiotomy syndrome (PPS) is worsening or new formation of pericardial and/or pleural effusion mostly 1 to 6 weeks after cardiac surgery, as a result of autoimmune inflammatory reaction within pleural and pericardial space. Its incidence varies among different studies and registries (2% to 30%), as well as according to the type of cardiac surgery performed. We conducted this retrospective analysis of PPS incidence and diagnostic and treatment strategies in patients referred for cardiac surgery for revascularization, valvular and/or aortic surgery. We retrospectively analyzed 461 patients referred for an urgent or elective cardiac surgery procedure between 2009 and 2015. PPS diagnosis was established using well defined clinical criteria. Demographic and clinical characteristics were used in regression subanalysis among patients having undergone surgery of aortic valve and/or ascending aorta. Within 6 weeks after cardiac surgery, 47 (10.2%) patients had PPS. The median time from the procedure to PPS diagnosis was 14 days. The incidence of PPS was 26% after aortic valve and/or aorta surgery, and 7.9% and 8.3% after coronary bypass and mitral valve surgery, respectively. Among patients subjected to aortic valve and/or aortic surgery, regression analysis showed significant association of fever, C-reactive protein (CRP) elevation between 5 and 100 mg/L, urgent procedure and postoperative antibiotic use with PPS diagnosis, whereas younger age showed near-significant association. All patients had complete resolution of PPS, mostly after corticosteroid therapy, with only 2 cases of recurrent PPS that successfully resolved after colchicine therapy. Pleural drainage was indicated in 15 (32%) patients, whereas only one patient required pericardial drainage. In conclusion, PPS incidence in our retrospective analysis was similar to previous reports. Patients having undergone aortic valve and/or aortic surgery were most likely to develop PPS. The most relevant clinical criteria for diagnosis in these patients were fever, CRP elevation between 5 and 100 mg/L, and pericardial and/or pleural effusion formation or worsening 2 weeks after cardiac surgery.

Background Postpericardiotomy syndrome (PPS) is a common complication after cardiac surgery. However, large‐scale epidemiological studies about the effect of procedure type on the occurrence of PPS and mortality of patients with PPS have not yet been performed. Methods and Results We studied the association of PPS occurrence with operation type and postoperative mortality in a nationwide follow‐up analysis of 28 761 consecutive patients entering coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or ascending aortic surgery. Only PPS episodes severe enough to result in hospital admission or to contribute as a cause of death were included. Data were collected from mandatory Finnish national registries between 2005 and 2014. Of all the patients included, 493 developed PPS during the study period. The occurrence of PPS was significantly higher after aortic valve replacement (hazard ratio, 1.97; 95% confidence interval, 1.58–2.46; P, See Editorial by https://doi.org/10.1161/JAHA.118.011118.

This is an in-depth review on the mechanism of action, clinical utility, and drug-drug interactions of colchicine in the management of pericardial disease. Recent evidence about therapeutic targets on pericarditis has demonstrated that NALP3 inflammasome blockade is the cornerstone in the clinical benefits of colchicine. Such benefits extend from acute and recurrent pericarditis to transient constriction and post-pericardiotomy syndrome. Despite the increased utilization of colchicine in cardiovascular medicine, safety concerns remains unsolved regarding the long-term use of colchicine in the cardiac patient. Moreover, recent evidence has demonstrated that numerous cardiovascular medications, ranging from antihypertensive medication to antiarrhythmics, are known to interact with the CYP3A4 and/or P-gp system increasing the toxicity potential of colchicine. The use of adjunctive colchicine in the management of inflammatory pericardial diseases is standard of care in current practice. It is advised that a careful medication reconciliation with emphasis on pharmacokinetic is completed before prescribing colchicine in order to avoid harmful interaction by finding an alternative regimen or adjusting colchicine dosing.

Postpericardiotomy syndrome (PPS) is a common complication after cardiac surgery. Previous epidemiological descriptions of the syndrome, however, are scarce.This retrospective analysis included all patients hospital admission due to PPS in patients aged 20-79 years. Data were collected from the Finnish national registry that included data on all cardiovascular hospital admissions (n = 51 7669) during 9.5 years in 29 Finnish hospitals nationwide.There were 760 hospital admissions due to PPS during the study period. The patients were more likely male than female (67.8% versus 32.2%) with an age-adjusted RR of 2.37 (95% CI 1.85-3.02) for men (p 0.0001). When evaluating the rate of PPS in relation to cardiac surgeries, female gender was associated with a higher incidence of PPS (RR 1.78; 95% CI 1.45-2.19; p 0.001). The rate of PPS in relation to the number of cardiac surgery was highest in youngest patients followed by a gradual decrease (RR 0.59; 95% CI 0.55-0.65; p 0.0001 per 10-year increment in age) with aging.Hospital admission due to PPS was most common in men in their sixties. When stratified by the total number of performed cardiac operations the incidence of PPS was higher among women and younger patients.

Colchicine is used extensively in the treatment of autoimmune and inflammatory disorders. Recent data have demonstrated additional benefit in a variety of cardiovascular disorders, including acute and recurrent pericarditis, postpericardiotomy syndrome, atrial fibrillation, stable ischemic heart disease, and possibly chronic heart failure. This article serves as a focused and updated discussion on the cardiovascular effects of colchicine and emphasizes the importance of randomized, placebo-controlled trials to further our clinical and pharmacological understanding of these findings.

Objectives Postpericardiotomy syndrome is a well-known complication after cardiac surgery. Nevertheless, little is known about the incidence and predictors of postpericardiotomy syndrome requiring medical attention or hospitalization in a contemporary set of patients undergoing isolated coronary bypass. Methods This retrospective analysis included 688 patients from 2008 to 2010. The median follow-up time was 5.3 [4.5-6.0] years. Results The incidence of postpericardiotomy syndrome was 61 of 688 patients (8.9%), and the median time to diagnosis was 21 [11-52] days, but only 13 patients (22%) required pleural drainage and 3 patients (4.9%) required pericardiocentesis. Patients with postpericardiotomy syndrome more often had 1 or more red blood cell units transfused (61% vs 43%, P = .008) after surgery and less often had diabetes (12% vs 31% P = .002) or metformin medication (3.3% vs 20%, P = .001) compared with those without postpericardiotomy syndrome. In multivariable Cox regression model, renal insufficiency and 1 or more red blood cell units transfused remained as independent predictors of postpericardiotomy syndrome and diabetes remained as a protective factor. Incidence of recurrences was high (38%), and increasing body mass index was the only predictor of relapse. Conclusions The incidence of symptomatic postpericardiotomy syndrome leading to medical care contact was markedly lower compared with that reported in older clinical studies. Postpericardiotomy syndrome was associated with the use of red blood cell units and was less common in patients with medically treated diabetes.

The aim of this study is to assess the safety and efficacy of colchicine in prevention of recurrence, symptom reduction, and complications in patients with pericarditis. Pericarditis is an important cause of chest pain leading to frequent emergency room visits and reduced quality of life. Pericarditis has traditionally been treated symptomatically with anti-inflammatory drugs, but growing evidence suggests the use of colchicine for both first episode and recurrent pericarditis in the prevention of recurrences and reducing symptoms. PubMed, EMBASE, and the Cochrane Central register of controlled trials (CENTRAL) databases were searched and the studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. All randomized clinical trials with head-to-head comparison between colchicine and standard of care were included. A total of five studies were included in the primary analysis of pericarditis and three in the analysis for prevention of post-pericardiotomy syndrome (PPS). Colchicine reduced the incidence rate of recurrent pericarditis in patients with both the first episode and recurrent pericarditis, compared with placebo [16.7 vs. 36.8%; risk ratio (RR) 0.46; 95% confidence interval (CI) 0.36-0.58; P < 0.00001; I(2) = 0%], with a significant increase in adverse effects (12.5 vs. 8.5%, RR 1.45; 95% CI 1.09-1.95; P = 0.01; I(2) = 0%) and drug withdrawal rate (10.8 vs. 8.5%; RR 1.44; 95% CI 1.01-2.05; P = 0.04; I(2) = 14%). In addition, colchicine decreased symptom duration in patients with recurrent pericarditis (63.1 vs. 78.6%; RR 0.58; 95% CI 0.39-0.87; P = 0.02; I(2) = 65%), but had no significant effect on symptom duration in patients with an initial episode of pericarditis (RR 0.91; 95% CI 0.65-1.28; P = 0.57; I(2) = 0%). Colchicine was superior to placebo in the prevention of PPS at 1 year (13.2 vs. 25.8%, RR 0.56, 95% CI 0.42-0.76; P < 0.01). In this quantitative analysis of randomized clinical data, colchicine demonstrated superior clinical efficacy compared with standard therapy for the prevention of recurrent pericarditis and PPS at the cost of a small increase in the incidence rate of side effects.

Background Postpericardiotomy syndrome ( PPS ) is a common complication after cardiac surgery. However, large‐scale epidemiological studies about the effect of procedure type on the occurrence of PPS and mortality of patients with PPS have not yet been performed. Methods and Results We studied the association of PPS occurrence with operation type and postoperative mortality in a nationwide follow‐up analysis of 28 761 consecutive patients entering coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or ascending aortic surgery. Only PPS episodes severe enough to result in hospital admission or to contribute as a cause of death were included. Data were collected from mandatory Finnish national registries between 2005 and 2014. Of all the patients included, 493 developed PPS during the study period. The occurrence of PPS was significantly higher after aortic valve replacement (hazard ratio, 1.97; 95% confidence interval, 1.58–2.46; P P P P P =0.014). Conclusions The occurrence of PPS was higher after aortic valve replacement, mitral valve replacement, and aortic surgery when compared with the coronary artery bypass grafting procedure. Aging decreased the risk of PPS . The development of PPS was associated with higher mortality within the first year after cardiac or ascending aortic surgery.

Introduction: Post-pericardiotomy syndrome is a well-recognized inflammatory phenomenon that commonly occurs in patients following cardiac surgery. Due to the increased morbidity and resource utilization associated with this condition, research has recently focused on ways of preventing its prevention this condition; primarily using colchicine, NSAIDs and corticosteroids. Areas covered: This systematic review summarizes the three clinical studies that have used corticosteroids for PPS primary prevention in the perioperative period. Due to the heterogeneity amongst these three studies in terms of population (both pediatric and adult patients), surgical procedure, administration regimen and results (only 1/3 studies reporting a positive effect), the effectiveness of corticosteroids remains unproven. Expert commentary: Corticosteroids have shown to be useful in the treatment of PPS but have thus far have shown mixed results as a primary prevention method. Research on patients taking corticosteroids pre-operatively have shown a significant reduction in the risk of developing PPS. Further research is required to determine if corticosteroids are helpful in preventing PPS in patient undergoing cardiac surgery, before any recommendations regarding their use in cardiovascular surgery can be made.

Background: Colchicine is an old drug originally employed for the treatment of inflammatory disorders such as acute gout and familiar Mediterranean fever. Methods: In the past few decades, colchicine has been at the forefront of the pharmacotherapy of several cardiac diseases, including acute and recurrent pericarditis, coronary artery disease, prevention of atrial fibrillation and heart failure. In this review, we have summarized the current evidence based medicine and guidelines recommendations in the specific context of pericardial syndromes. Results: Colchicine has been firstly engaged in the treatment of recurrent pericarditis of viral, idiopathic and autoimmune origin. Shortly thereafter colchicine use has been expanded to the primary prevention of recurrences in patients with a first episode of pericarditis depicting similarly good results. The acquisition of high quality scientific data in the course of time from prospective randomized placebo-controlled trials and metanalyses have established colchicine as first line treatment option in acute and recurrent pericarditis, on top of the conventional treatment. The only concerns related to the use of colchicine are the side effects (mainly gastrointestinal intolerance) which although generally not serious, may account for treatment withdrawal in some cases. Conclusion: Colchicine has been established as a first line medication in the treatment of acute (first episode) and recurrent pericarditis on top of the conventional treatment as well as for the prevention of postpericardiotomy syndrome. It depicts a good safety profile with gastrointestinal intolerance being the most common side effect.

We report a case of a patient presenting with abdominal pain after cardiac surgery who was noted on point-of-care ultrasound (POCUS) to have pericardial and pleural effusion, in addition to ascites. The most notable findings were pleural and pericardial effusions, which combined with symptomatology met criteria for postpericardiotomy syndrome. Point-of-care ultrasound expedited the diagnosis of a pericardial effusion with impending tamponade and transfer for pericardiocentesis and placement of pericardial drain.

Acute pericarditis is the most common disease of the pericardium encountered in clinical practice. It is diagnosed in 0.1% of all admissions and 5% of emergency room admissions for chest pain. In developed countries, it is usually due to a benign cause. Idiopathic and infectious pericarditis are more common than secondary to surgical pericardiotomy or neoplastic causes, whereas tuberculosis is the dominant cause in developing countries. The most common symptoms of pericarditis are characteristic chest pain and fever. Since pericarditis presents a benign outcome because of self-limiting and good response to conventional anti-inflammatory therapy, it can be safely managed on outpatient basis unless a specific cause is suspected or the patient has high-risk features to avoid complications such as pericardial effusion, cardiac tamponade or recurrent pericarditis. We report a case of pericarditis, diagnosed 9 months after surgical closure of an atrial septal defect, in a 7-year-old boy with favorable evolution.

Colchicine is a well-established drug approved by the Food and Drug Administration (FDA) for the prevention and treatment of gout. It possesses unique anti-inflammatory properties. Interests in the usage of colchicine in cardiovascular medicine have been rekindled recently with several large trials been carried out to investigate its efficacy in treatment of various cardiac conditions including pericarditis, postpericardiotomy syndrome, atrial fibrillation and coronary artery disease. In this review, the basic pharmacological properties of colchicine will be discussed, and the evidences of its benefits for different applications in cardiovascular medicine will be reviewed.