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A 52 year old man with ischaemic heart failure was evaluated with cardiovascular magnetic resonance imaging (CMR) before coronary artery bypass surgery (CABG), demonstrating a dilated left ventricle with depressed ejection fraction (panel A). Surgery was performed without complications and the patient recovered well. CMR was repeated three months after the procedure for routine evaluation of cardiac function. Besides recovery of left ventricular function, approximately 350 ml of pericardial effusion was observed located posterior to the left and right ventricle (panel B). There were, however, no signs of tamponade from a clinical point of view and the patient was asymptomatic. Follow up CMR six months after CABG revealed notable resolution of the pericardial effusion (panel C).
The presence of pericardial effusion shortly after cardiac surgery is mainly detected clinically when a patient develops right and/or left sided heart failure, usually accompanied by chest discomfort, a pericardial rub, fever, and leucocytosis. This condition is often referred to as post-pericardiotomy syndrome. The vast majority of patients recover from cardiac surgery without these symptoms, and therefore no diagnostic effort is being made to detect pericardial effusion. However, postoperative pericardial effusion is considerably more common than clinically apparent, and occurs in as many as 85% of patients. Although anti-inflammatory agents may be useful to facilitate resolution, postoperative pericardial effusion is usually transient and the clinical course benign.