Post MVP Surgery Pericarditis

[PatrickJam]

I am a 38 year old male who had minimally invasive (keyhole) surgery to repair MVP in January of 2006.  Since then, I have had three recurrances of pericarditis.  One in June 2006, again in July and now in January 2007.  The symptoms are chest and sometimes excruciating neck / shoulder pain, however no fever or swelling exist.  I have had some dry cough and feel typically weak.  During my second bout with these symptoms, I spent a weekend in the hospital having several blood tests performed, including cultures.  All were negative.  With this most recent flare up, my cardiologist has prescribed for me 500mg Naproxin once a day for the pain / inflammation.  The only other medication I am on routinely is aspirin therapy following my surgery.  Another strange symptom I have been experiencing over the past several months is chronic tinnitus in my right ear.  

Is it possible these symptoms are related and what could be the cause of the recurring pericarditis? Should I be concerned about the long term effects of these symptoms?

[lnj81]

I am a 46 year old woman who had WPW Syndrome.  In May, '05 had a radio frequency ablation done to get rid of WPW.  During procedure, doctor punctured my heart and I developed fluid around my heart.  I was in ICU for 6 days when they decided to drain the fluid.  After the fluid was drained (approx. 24 hours) the doctor pulled the tube from my chest.  I felt a sharp pain in my left shoulder and told him so.  He said he wasn't near my shoulder.  I was in the hospital another 4 days (went into A-fib during that time as well).  When I came home I wasn't feeling well.  I still felt the pressure around my heart, but they told me that was normal.  In July, '05, the pain and fluid came back.  They put me on Prednisone and Naproxen for 3 months.  Once I was off the meds for a few weeks the pain and pressure came back. They tried to tell me that it wasn't the fluid causing the pain (they said I was experiencing anxiety) and had another echo done (after a lot of insisting on my part).  They said the fluid came back and told me I had Dressler's Syndrome and put me back on Prednisone & Naproxen for another 3 months.  Again, after a few weeks the pain came back.  Again...same treatment and this time telling me that I had recurrent pericarditis with fibrosis.  After seeing another doctor who said he could help, put me on Prednisone for 6 months.  Now the pain (and fluid) are back again.  I am now on my 4th cardiologist.  This doctor has me on a low dosage of Prednisone and .06 mg of Colchocine.  I still feel the pressure and the lower the dosage of Prednisone, the worse I feel.  The pain is so intense, that I have considered having a pericardectomy (to remove the pericardial wall around my heart).  I want to know what is making the fluid come back.  What is causing the pain?  My last doctor said that the fluid around my heart was an "insignificant" amount and shouldn't be causing me such pain.  What about the fibrosis?  Could it be aggravating that?  Can this pain cause a stroke?  I have so many questions and no one has been able to help me.  Has anyone ever heard of this before??

[MsFixIt]

I'm 43. Had minimally invasive mitral repair 1999. Started with pericarditis a year later.  Next episode 1 year, then 6 months, then 3....on and on until last year when episode started again and never resolved.  Meds needed to resolve increased from simple NSAID's to prednisone until now that doesn't even work.  Seeing a rheumatologist and using methotrexate and plaquenil along with NSAID, colchicine and lots of pain killers.  Univ. of PA doctors have seen several people like me from early years of this surgery. (Late onset, recurring pericarditis, no damage occurring, no medical tests showing significant changes, just lots of pain.  Are there any studies being done on this anywhere or treatments being investigated?  Local cardiologists seem at a loss and this problem should be studied and published.

[thehusband]

My wife also has post-surgical pericarditis.  The symptoms started 11 weeks after her mitral valve repair and closure of her atrial septal defect, right around the time the post surgical pain had all but subsided and she was looking forward to getting back to normal activities.  She is able to tear the heck out of our treadmill, walking at 4.2 mi.hr and jogging much faster than that for combined periods of up to an hour...she just has to do this without taking a deep breath-yeah-you read that right.

Her cardiologist identified the disease as "Dressler's Syndrome".  90 minutes of web searching has not clarified our understanding of the diseasee at all, but I will tell you that Advil has helped her chest pain and right shoulder pain a lot more than Celebrex.  The drugs have a totally difference mechanism of action, so this is not a surprise.  The low grade fever and difficulty taking a deep breath continues.

Chest x-ray normal.  ECG normal-including daily submissions of her event monitor.  Echocardiogram and interrogation of her pacemaker are scheduled for a week from now.

[Cleveland Clinic]

Patrick,

We often see pericarditis after heart surgery as the inflammation around the heart dissipates.

Your symptoms have gone on pretty long after what we would expect the normal pattern. I would be interested if there is specific evidence of pericarditis such as a pericardial effusion or ecg changes associated with your episodes.

In some patients with recurrent pericarditis, the pericardium can scar down and cause some problems with the heart fucntion.  Unfortunately, there is no good treatment for patients with recurrence of symptoms.

I dont believe that the tinnitus is related, other than NSAID use (such as naproxen) can be associated with it.

good luck