Timing of surgery after pericarditis

Gabrielle Morris

54yo lady, laparoscopic oopherectomy

Background

  • Ovarian Cyst – on background of family history of ovarian cancer
  • OSA – complaint with CPAP therapy
  • PHTN – Stable, PASP = 50mmHG. Regular cardiology follow-up
  • Pericardial Effusion, Restrictive Pericarditis, and Pleural Effusion – May 2022 requiring thoracoscopic drainage, pleurodesis, and pericardial biopsy. Aetiology unknown, no recurrence. On reducing dose prednisolone. NYHA 3 dyspnoea.
  • NIDDM – HbA1c = 8.3%.
  • COPD – mild, no admissions, Distant ex-smoker
  • HTN and dyslipidaemia
  • Schizophrenia, PTSD and depression – stable disease
  • DASI METS 5.3

Issues

  • Timing of surgery after pericarditis and pericardial/pleural effusions
  • Opportunities for optimisation

Discussion

  • Ideal timing from pericarditis – unknown
  • ? Cardiopulmonary rehab – may be offered at Armidale
  • Surgeon says no urgency for surgery given Ca125 stable however ? reliability of Ca125 given we don’t use it as a screening tool in general population. Must be guided by experience and expertise of the gynae oncology team.
  • Indication for surgery – would likely meet the criteria for consideration of surgery even without her anxiety, given FHx
  • ? discuss with rheumatologist or possibly at the PHTN MDT

Plan

  • Discuss cardiopulmonary rehab with patient
  • Discuss patient with rheumatologist
  • Given stable, small pericardial effusion and no evidence of HD compromise, appropriate to proceed to surgery from HD-stability perspective.
  • Unclear re timing of surgery at pericarditis – for further discussion with cardiologist.