Clinical features and long-term natural history of the postpericardiotomy syndrome

We followed 34 consecutive patients with the postpericardiotomy syndrome for a median of 7 years. In each patient, the syndrome was documented by the occurrence of: (1) a pericardial type of pain or pericardial rub (or both); and (2) fever or an elevated erythrocyte sedimentation rate. The postpericardiotomy syndrome occurred at a median postoperative time of 4 weeks (range, 2 to 52 weeks). The duration of the syndrome was highly variable (range, 2 to 100 days; median, 22 days) and depended primarily on treatment; the median duration of symptoms in 21 patients treated with salicylates alone was only 4 days. Of the 9 patients receiving anticoagulants alone and in whom this treatment was continued, none had clinical evidence of hemopericardium. On follow-up, 7 patients (21%) had an initial recurrence at an interval of 1 to 3 months; 5 of these patients had further recurrences at an interval of 3 to 30 months. This long-term study indicates that the postperiocardiotomy syndrome is a benign but often recurrent clinical entity, presumably related to viral and/or immunologic factors.