Pleural effusions following cardiac surgery
- John E Heffner, MD
John E Heffner, MD
- Professor of Medicine
- Oregon Health & Science University
- Providence Portland Medical Center
Postoperative pleural effusions are common in patients who undergo cardiac surgery [1-13]. Most of these effusions develop as a consequence of the surgical procedure itself ("nonspecific pleural effusions") and follow a generally benign course. Postoperative pleural effusions may also occur with postpericardiotomy syndrome (PPCS, also known as the postcardiac injury syndrome or Dressler's syndrome), or as the initial manifestation of a potentially serious complicating event, such as heart failure or pulmonary embolism (table 1).
The extent of the evaluation required for a postoperative pleural effusion depends upon the presence of associated cardiovascular symptoms and the volume, timing of onset, progression, and persistence of the pleural effusion. Effusions with the following characteristics almost invariably represent nonspecific pleural effusions, and require only observation:
●Small to moderate in size
●Present within one to two days after surgery and not progressive
●Not associated with respiratory symptoms
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Feb 23, 2016.References
- Light RW. Pleural effusions after coronary artery bypass graft surgery. Curr Opin Pulm Med 2002; 8:308.
- Peng MJ, Vargas FS, Cukier A, et al. Postoperative pleural changes after coronary revascularization. Comparison between saphenous vein and internal mammary artery grafting. Chest 1992; 101:327.
- Vargas FS, Cukier A, Hueb W, et al. Relationship between pleural effusion and pericardial involvement after myocardial revascularization. Chest 1994; 105:1748.
- Vargas FS, Cukier A, Terra-Filho M, et al. Relationship between pleural changes after myocardial revascularization and pulmonary mechanics. Chest 1992; 102:1333.
- Allen BS, Buckberg GD, Rosenkranz ER, et al. Topical cardiac hypothermia in patients with coronary disease. An unnecessary adjunct to cardioplegic protection and cause of pulmonary morbidity. J Thorac Cardiovasc Surg 1992; 104:626.
- Landymore RW, Howell F. Pulmonary complications following myocardial revascularization with the internal mammary artery graft. Eur J Cardiothorac Surg 1990; 4:156.
- Kollef MH. Chronic pleural effusion following coronary artery revascularization with the internal mammary artery. Chest 1990; 97:750.
- Bevelaqua F, Garritan S, Haas F, et al. Complications after cardiac operations in patients with severe pulmonary impairment. Ann Thorac Surg 1990; 50:602.
- Florence SH, Hutton LC, McKenzie FN, Kostuk WJ. Cardiac transplantation: postoperative chest radiographs. Can Assoc Radiol J 1988; 39:115.
- Shirazi KK, Amendola MA, Tisnado J, et al. Radiographic findings in the chest of patients following cardiac transplantation. Cardiovasc Intervent Radiol 1983; 6:1.
- Kollef MH, Peller T, Knodel A, Cragun WH. Delayed pleuropulmonary complications following coronary artery revascularization with the internal mammary artery. Chest 1988; 94:68.
- Kollef MH. Symptomatic pleural effusion after coronary artery revascularization: unsuspected pleural injury from internal mammary artery resection. South Med J 1993; 86:585.
- Ikäheimo MJ, Huikuri HV, Airaksinen KE, et al. Pericardial effusion after cardiac surgery: incidence, relation to the type of surgery, antithrombotic therapy, and early coronary bypass graft patency. Am Heart J 1988; 116:97.
- Duntley P, Siever J, Korwes ML, et al. Vascular erosion by central venous catheters. Clinical features and outcome. Chest 1992; 101:1633.
- Chaiyaroj S, Mullerworth MH, Tatoulis J. Surgery in the management of chylothorax after coronary artery bypass with left internal mammary artery. J Thorac Cardiovasc Surg 1993; 106:754.
- Light RW, Rogers JT, Cheng D, Rodriguez RM. Large pleural effusions occurring after coronary artery bypass grafting. Cardiovascular Surgery Associates, PC. Ann Intern Med 1999; 130:891.
- Hurlbut D, Myers ML, Lefcoe M, Goldbach M. Pleuropulmonary morbidity: internal thoracic artery versus saphenous vein graft. Ann Thorac Surg 1990; 50:959.
- Jain U, Rao TL, Kumar P, et al. Radiographic pulmonary abnormalities after different types of cardiac surgery. J Cardiothorac Vasc Anesth 1991; 5:592.
- Light RW, Rogers JT, Moyers JP, et al. Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery. Am J Respir Crit Care Med 2002; 166:1567.
- Nikas DJ, Ramadan FM, Elefteriades JA. Topical hypothermia: ineffective and deleterious as adjunct to cardioplegia for myocardial protection. Ann Thorac Surg 1998; 65:28.
- Vargas FS, Uezumi KK, Janete FB, et al. Acute pleuropulmonary complications detected by computed tomography following myocardial revascularization. Rev Hosp Clin Fac Med Sao Paulo 2002; 57:135.
- Ali-Hassan-Sayegh S, Mirhosseini SJ, Vahabzadeh V, Ghaffari N. Should the integrity of the pleura during internal mammary artery harvesting be preserved? Interact Cardiovasc Thorac Surg 2014; 19:838.
- Ali IM, Lau P, Kinley CE, Sanalla A. Opening the pleura during internal mammary artery harvesting: advantages and disadvantages. Can J Surg 1996; 39:42.
- Kalomenidis I, Stathopoulos GT, Barnette R, et al. Vascular endothelial growth factor levels in post-CABG pleural effusions are associated with pleural inflammation and permeability. Respir Med 2007; 101:223.
- Heidecker J, Sahn SA. The spectrum of pleural effusions after coronary artery bypass grafting surgery. Clin Chest Med 2006; 27:267.
- Peng MC, Hou CJ, Li JY, et al. Prevalence of symptomatic large pleural effusions first diagnosed more than 30 days after coronary artery bypass graft surgery. Respirology 2007; 12:122.
- Sadikot RT, Rogers JT, Cheng DS, et al. Pleural fluid characteristics of patients with symptomatic pleural effusion after coronary artery bypass graft surgery. Arch Intern Med 2000; 160:2665.
- Labidi M, Baillot R, Dionne B, et al. Pleural effusions following cardiac surgery: prevalence, risk factors, and clinical features. Chest 2009; 136:1604.
- Usta E, Mustafi M, Ziemer G. Ultrasound estimation of volume of postoperative pleural effusion in cardiac surgery patients. Interact Cardiovasc Thorac Surg 2010; 10:204.
- Cohen M, Sahn SA. Resolution of pleural effusions. Chest 2001; 119:1547.
- Paull DE, Delahanty TJ, Weber FJ, Harostock MD. Thoracoscopic talc pleurodesis for recurrent, symptomatic pleural effusion following cardiac operations. Surg Laparosc Endosc Percutan Tech 2003; 13:339.
- Lee YC, Vaz MA, Ely KA, et al. Symptomatic persistent post-coronary artery bypass graft pleural effusions requiring operative treatment : clinical and histologic features. Chest 2001; 119:795.
- DRESSLER W. The post-myocardial-infarction syndrome: a report on forty-four cases. AMA Arch Intern Med 1959; 103:28.
- Lehto J, Gunn J, Karjalainen P, et al. Incidence and risk factors of postpericardiotomy syndrome requiring medical attention: The Finland postpericardiotomy syndrome study. J Thorac Cardiovasc Surg 2015; 149:1324.
- Jerjes-Sanchez C, Ibarra-Perez C, Ramirez-Rivera A, et al. Dressler-like syndrome after pulmonary embolism and infarction. Chest 1987; 92:115.
- Tabatznik, B, Isaac, JP. Postpericardiotomy syndrome following traumatic hemopericardium. Am J Cardiol 1961; 7:73.
- Snow ME, Agatston AS, Kramer HC, Samet P. The postcardiotomy syndrome following transvenous pacemaker insertion. Pacing Clin Electrophysiol 1987; 10:934.
- Gungor B, Ucer E, Erdinler IC. Uncommon presentation of postcardiac injury syndrome: acute pericarditis after percutaneous coronary intervention. Int J Cardiol 2008; 128:e19.
- Zheng LR, Hu X, Xia S, Chen Y. Postcardiac injury syndrome following radiofrequency ablation of idiopathic left ventricular tachycardia. J Interv Card Electrophysiol 2007; 18:269.
- Yukumi S, Ichiki H, Funada J, et al. Postcardiac injury syndrome following vascular interventional radiofrequency ablation for paroxysmal atrial fibrillation. Respir Med Case Rep 2015; 15:89.
- Verma S, Eikelboom JW, Nidorf SM, et al. Colchicine in cardiac disease: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2015; 15:96.
- Tralhão A, Cavaco D, Trabulo M, Ferreira AM. The return of a disappearing entity: Dressler's syndrome after transvenous pacemaker implantation. BMJ Case Rep 2014; 2014.
- Imazio M. The post-pericardiotomy syndrome. Curr Opin Pulm Med 2012; 18:366.
- Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the Diagnosis and Management of Pericardial Diseases. Rev Esp Cardiol (Engl Ed) 2015; 68:1126.
- Imazio M, Brucato A, Ferrazzi P, et al. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA 2014; 312:1016.
- Walshe C, Phelan D, Bourke J, Buggy D. Vascular erosion by central venous catheters used for total parenteral nutrition. Intensive Care Med 2007; 33:534.
- Misawa Y, Fuse K, Hasegawa T. Infectious mediastinitis after cardiac operations: computed tomographic findings. Ann Thorac Surg 1998; 65:622.