Ann Thorac Surg 2000;69:S191-S196
© 2000 The Society of Thoracic Surgeons
Congenital Heart Surgery Nomenclature and Database Project: diseases of the pericardium
Sanjay M. Mehta, MDa,
John L. Myers, MDa
a Pediatric Cardiovascular Surgery, Children’s Hospital, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania, USA
Address reprint requests to Dr Myers, Pediatric Cardiovascular Surgery, Children’s Hospital at Milton S. Hershey Medical Center, Pennsylvania State University, 500 University Dr, Hershey, PA 17033
e-mail: jlmyers{at}psghs.edu
Presented at the International Nomenclature and Database Conferences for Pediatric Cardiac Surgery, 1998–1999.
Abstract
The extant nomenclature for pericardial disease is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories, using synonyms where appropriate. No classification system has been reported. The groups were based on disease processes, and include: effusive pericarditis (pericardial effusion), constrictive pericarditis, cardiac tamponade, postoperative pericardial effusion, postoperative cardiac tamponade, postpericardiotomy syndrome, congenital defect, neoplastic process, benign mass, pericardial cyst, pneumopericardium, and chylopericardium. A comprehensive database set is presented that is based on a hierarchical scheme. Data are entered at various levels of complexity and detail, which can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented that will allow for data sharing and would lend itself to basic interpretation of trends.
I. Background
A complete discussion of diseases of the pericardium includes a spectrum of acquired and congenital problems [1–5]. Structural deficiencies, infectious and inflammatory processes, and neoplastic lesions must all be considered. Though a classification scheme for the range of pericardial disease has not been described, this document makes every attempt to include the diverse group of problems encountered when treating patients with pericardial disease.
II. Analysis: a unified pericardial disease nomenclature system
Pericardial disease hierarchy level 1
- Pericardial disease
Pericardial disease hierarchy level 1 definitions
- Pericardial disease: A structural or functional abnormality of the visceral or parietal pericardium that may, or may not, have a significant impact on cardiac function.
Pericardial disease hierarchy level 2
- Pericardial disease, NOS
- Pericardial disease, Effusive pericarditis (pericardial effusion)
- Pericardial disease, Constrictive pericarditis
- Pericardial disease, Cardiac tamponade
- Pericardial disease, Postoperative pericardial effusion
- Pericardial disease, Postoperative cardiac tamponade
- Pericardial disease, Postpericardiotomy syndrome
- Pericardial disease, Congenital defect
- Pericardial disease, Neoplastic process
- Pericardial disease, Benign mass
- Pericardial disease, Pericardial cyst
- Pericardial disease, Pneumopericardium
- Pericardial disease, Chylopericardium
Pericardial disease hierarchy level 2 definitions
- Pericardial disease, NOS: Pericardial disease not otherwise specified.
- Pericardial disease, Effusive pericarditis (pericardial effusion): Inflammatory stimulation of the pericardium that results in the accumulation of appreciable amounts of pericardial fluid.
- Pericardial disease, Constrictive pericarditis: An inflammatory process of the fibrous and serous layers of the pericardium that leads to pericardial thickening and compression of the cardiac chambers, ultimately with an associated significant reduction in cardiac function.
- Pericardial disease, Cardiac tamponade: Cardiac compression.
- Pericardial disease, Postoperative pericardial effusion: A fluid collection in the pericardium, after a surgical intervention, that requires treatment
- Pericardial disease, Postoperative cardiac tamponade: Cardiac compression after surgical intervention.
- Pericardial disease, Postpericardiotomy syndrome: Pericardial inflammation secondary to either cardiac muscle damage or surgical cardiotomy, associated with pain, friction rub, and electrocardiographic changes suggestive of ischemia.
- Pericardial disease, Congenital defect: Congenital defects of the pericardium comprise a rare group of lesions that range from isolated defects to complete absence of the pericardium. These lesions may be completely asymptomatic, but often are associated with marked hemodynamic compromise.
- Pericardial disease, Neoplastic processes: Malignant disease involving pericardium or pericardial space.
- Pericardial disease, Benign mass: A benign mass involving pericardium or pericardial space.
- Pericardial disease, Pericardial cyst: Cystic lesion found in close proximity, though rarely communicating with, the pericardium, commonly containing clear yellow fluid, and rarely associated with symptoms.
- Pericardial disease, Pneumopericardium: Finding of air within the pericardium.
- Pericardial disease, Chylopericardium: Chylous effusive process of the pericardium.
Pericardial disease hierarchy level 3
- Pericardial disease, NOS
- Pericardial disease, Effusive pericarditis (pericardial effusion), NOS
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Idiopathic
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Viral
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Uremic
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Tuberculous
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Purulent
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Neoplastic
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Traumatic
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Traumatic—Hemopericardium (mediastinal bleeding)
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Drug induced
- Pericardial disease, Constrictive pericarditis, NOS
- Pericardial disease, Constrictive pericarditis, Idiopathic
- Pericardial disease, Constrictive pericarditis, Viral
- Pericardial disease, Constrictive pericarditis, Effusive
- Pericardial disease, Constrictive pericarditis, Post-cardiotomy
- Pericardial disease, Constrictive pericarditis, Radiation induced
- Pericardial disease, Cardiac tamponade
- Pericardial disease, Postoperative pericardial effusion, NOS
- Pericardial disease, Postoperative pericardial effusion, Early
- Pericardial disease, Postoperative pericardial effusion, Early—hemopericardium (mediastinal bleeding)
- Pericardial disease, Postoperative pericardial effusion, Late
- Pericardial disease, Postoperative cardiac tamponade, NOS
- Pericardial disease, Postoperative cardiac tamponade, Early
- Pericardial disease, Postoperative cardiac tamponade, Late
- Pericardial disease, Postpericardiotomy syndrome
- Pericardial disease, Congenital defect, NOS
- Pericardial disease, Congenital defect, Complete absence of pericardium
- Pericardial disease, Congenital defect, Left-sided defect of pericardium
- Pericardial disease, Congenital defect, Right-sided defect of pericardium
- Pericardial disease, Neoplastic process, NOS
- Pericardial disease, Neoplastic process, Lymphoma
- Pericardial disease, Neoplastic process, Leukemia
- Pericardial disease, Neoplastic process, Thymoma
- Pericardial disease, Neoplastic process, Mesothelioma
- Pericardial disease, Neoplastic process, Teratoma
- Pericardial disease, Neoplastic process, Angiosarcoma
- Pericardial disease, Neoplastic process, Rhabdomyosarcoma
- Pericardial disease, Neoplastic process, Metastatic
- Pericardial disease, Benign mass
- Pericardial disease, Pericardial cyst, NOS
- Pericardial disease, Pericardial cyst, Right periphrenic
- Pericardial disease, Pericardial cyst, Left periphrenic
- Pericardial disease, Pericardial cyst, Mediastinal—intrapericardial
- Pericardial disease, Pericardial cyst, Mediastinal—extrapericardial
- Pericardial disease, Pneumopericardium, NOS
- Pericardial disease, Pneumopericardium, Idiopathic
- Pericardial disease, Pneumopericardium, Traumatic
- Pericardial disease, Pneumopericardium, Infectious
- Pericardial disease, Chylopericardium, NOS
- Pericardial disease, Chylopericardium, Idiopathic
- Pericardial disease, Chylopericardium, Post-traumatic
- Pericardial disease, Chylopericardium, Postthoracic surgery
- Pericardial disease, Chylopericardium, Post-cardiotomy
- Pericardial disease, Chylopericardium, Neoplastic
Pericardial disease hierarchy level 3 definitions
- Pericardial disease, Effusive pericarditis (Pericardial effusion), NOS: Effusive pericarditis (pericardial effusion) not otherwise specified.
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Idiopathic: Effusive pericarditis without identified cause that may be associated with fibrous exudate.
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Viral: Effusive pericarditis caused by a viral infection often in association with other manifestations of a viral infection.
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Uremic: Effusive pericarditis associated with renal failure and uremia of unknown etiology, with common symptoms of chest pain, fever, and pericardial friction rub.
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Tuberculous: Pericarditis associated with tuberous infection commonly presenting as an effusive process, but prone to progress to constrictive pericarditis with significant associated calcium deposition.
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Purulent: Infectious process of pericarditis, which may arise from contiguous spread or blood-born infection.
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Neoplastic: Effusive pericardial disease associated with a local or distinct malignancy.
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Traumatic: Effusive pericarditis associated with traumatic injury to the pericardium.
- Pericardial disease, Effusive pericarditis (Pericardial effusion), Drug induced: Effusive pericarditis secondary to ongoing medical therapy with a pharmacologic agent associated with the development of this pericardial process.
- Pericardial disease, Constrictive pericarditis, NOS: Constrictive pericarditis not otherwise specified.
- Pericardial disease, Constrictive pericarditis, Idiopathic: Constrictive pericarditis of unknown etiology.
- Pericardial disease, Constrictive pericarditis, Viral: Constrictive pericarditis associated with systemic or local viral infection.
- Pericardial disease, Constrictive pericarditis, Effusive: Effusive disease associated with thickened pericardium characterized by a lack of cardiac tamponade symptoms after drainage of pericardial fluid.
- Pericardial disease, Constrictive pericarditis, Postcardiotomy: Constrictive pericarditis after previous cardiac surgical procedure.
- Pericardial disease, Constrictive pericarditis, Radiation induced: Constrictive pericarditis following external beam radiation, often associated with restrictive myocardial fibrosis and ischemic cardiomyopathy. This disease is a radiation dose dependent disease of the pericardium.
- Pericardial disease, Postoperative pericardial effusion, NOS: Postoperative pericardial effusion that is not further described.
- Pericardial disease, Postoperative pericardial effusion, Early: Postoperative pericardial effusion that presents during the immediate perioperative period (<30 days).
- Pericardial disease, Postoperative pericardial effusion, Late: Postoperative pericardial effusion that presents at a time removed from the immediate perioperative period (
30 days).
- Pericardial disease, Postoperative cardiac tamponade, NOS: Postoperative cardiac tamponade that is not further described.
- Pericardial disease, Postoperative cardiac tamponade, Early: Postoperative cardiac tamponade that presents during the immediate perioperative period (< 30 days).
- Pericardial disease, Postoperative cardiac tamponade, Late: Post-operative cardiac tamponade that presents at a time removed from the immediate perioperative period ( 30 days).
- Pericardial disease, Congenital defect, NOS: A congenital defect of the pericardium not otherwise specified.
- Pericardial disease, Congenital defect, Complete absence of pericardium: Rare congenital condition marked by a complete absence of pericardium, most commonly found to be asymptomatic.
- Pericardial disease, Congenital defect, Left-sided defect of pericardium: Most common form of congenital pericardial defect resulting from premature atrophy of left common cardinal vein or duct of cuvies.
- Pericardial disease, Congenital defect, Right-sided defect of pericardium: Congenital defect of right pericardium associated with premature atrophy of right duct of cuvies.
- Pericardial disease, Neoplastic process, NOS: A neoplastic process of the pericardium not otherwise specified.
- Pericardial disease, Neoplastic process, Lymphoma: A primary extranodal lymphoma of the pericardium.
- Pericardial disease, Neoplastic process, Leukemia: Nodular lesions of the pericardium found to contain rests of neoplastic cells consistent with a hematogenous malignancy.
- Pericardial disease, Neoplastic process, Thymoma: A primary or contiguous thymic tumor involving the pericardium.
- Pericardial disease, Neoplastic process, Mesothelioma: A primary or contiguous mesothelioma involving the pericardium.
- Pericardial disease, Neoplastic process, Teratoma: A primary teratoma found within or involving the pericardium.
- Pericardial disease, Neoplastic process, Angiosarcoma: A primary or contiguous angiosarcoma involving the pericardium.
- Pericardial disease, Neoplastic process, Rhabdomyosarcoma: A primary or contiguous rhabdomyosarcoma involving the pericardium.
- Pericardial disease, Neoplastic process, Metastatic disease: A neoplastic process involving the pericardium that is derived from a distant primary tumor.
- Pericardial disease, Pericardial cyst, NOS: A pericardial cyst that is not further described.
- Pericardial disease, Pericardial cyst, Right periphrenic: A pericardial cyst found to arise from within the mediastinal fat along the right periphrenic angle.
- Pericardial disease, Pericardial cyst, Left periphrenic: A pericardial cyst found to arise from within the mediastinal fat along the left periphrenic angle.
- Pericardial disease, Pericardial cyst, Mediastinal—intrapericardial: A pericardial cyst found to arise within the anterior mediastinum within the pericardial space.
- Pericardial disease, Pericardial cyst, Mediastinal—extrapericardial: A pericardial cyst found to arise within the anterior mediastinum, but outside the pericardial space.
- Pericardial disease, Pneumopericardium, NOS: Pneumopericardium not otherwise specified.
- Pericardial disease, Pneumopericardium, Idiopathic: Pneumopericardium that is found without any discernable etiology.
- Pericardial disease, Pneumopericardium, Traumatic: Pneumopericardium that presents in the face of a traumatic injury to the patient.
- Pericardial disease, Pneumopericardium, Infectious: Pneumopericardium that results in association with a mediastinal infection.
- Pericardial disease, Chylopericardium, NOS: Chylous effusive process of the pericardium not otherwise specified.
- Pericardial disease, Chylopericardium, Idiopathic: A chylous pericardial effusion that arises without an identifiable cause.
- Pericardial disease, Chylopericardium, Post-traumatic: A chylous pericardial effusion that occurs in the context of a direct traumatic injury.
- Pericardial disease, Chylopericardium, Post-thoracic operation: A chylous pericardial effusion that occurs in the context of a previous thoracic surgical intervention.
- Pericardial disease, Chylopericardium, Post-cardiotomy: A chylous pericardial effusion that occurs in the context of a previous intrapericardial surgical intervention.
- Pericardial disease, Chylopericardium, Neoplastic: A chylous pericardial effusion that occurs in the presence of an intrathoracic malignancy.
III. Nomenclature for pericardial disease treatment options
Pericardial disease treatment hierarchy level 1
- Pericardial Disease
Pericardial disease treatment hirearchy level 2
- Pericardial disease, NOS
- Pericardial disease, Pericardial biopsy
- Pericardial disease, Pericardial drainage
- Pericardial disease, Pericardiectomy
- Pericardial disease, Mass excision
- Pericardial disease, Cyst excision
- Pericardial disease, Pericardial reconstruction
- Pericardial disease, Medical management
Pericardial disease treatment hierarchy level 3
- Pericardial disease, NOS
- Pericardial Disease, Pericardial biopsy, NOS
- Pericardial Disease, Pericardial biopsy, Incisional
- Pericardial Disease, Pericardial biopsy, Excisional
- Pericardial Disease, Pericardial drainage, NOS
- Pericardial Disease, Pericardial drainage, Pericardiocentesis
- Pericardial Disease, Pericardial drainage, Pericardiostomy tube
- Pericardial Disease, Pericardial drainage, Pericardial window
- Pericardial Disease, Pericardial drainage, Open pericardial drainage (pericardiotomy)
- Pericardial Disease, Pericardiectomy, NOS
- Pericardial Disease, Pericardiectomy, Median sternotomy without cardiopulmonary bypass
- Pericardial Disease, Pericardiectomy, Median sternotomy with cardiopulmonary bypass
- Pericardial Disease, Pericardiectomy, Thoracotomy without cardiopulmonary bypass
- Pericardial Disease, Pericardiectomy, Thoracotomy with cardiopulmonary bypass
- Pericardial Disease, Pericardiectomy, Thoracoscopic
- Pericardial Disease, Mass excision, NOS
- Pericardial Disease, Mass excision, Debulking
- Pericardial Disease, Mass excision, Complete excision
- Pericardial disease, Cyst excision
- Pericardial disease, Pericardial reconstruction for congenital absence, NOS
- Pericardial Disease, Pericardial reconstruction for congenital absence, Open completion pericardial resection
- Pericardial Disease, Pericardial reconstruction for congenital absence, Open with pericardial patch
- Pericardial Disease, Pericardial reconstruction for congenital absence, Open with prosthetic patch
- Pericardial Disease, Pericardial reconstruction for congenital absence, Thoracoscopic completion pericardial resection
- Pericardial Disease, Pericardial reconstruction for congenital absence, Thoracoscopic pericardial patch
- Pericardial Disease, Pericardial reconstruction for congenital absence, Thoracoscopic prosthetic patch
- Pericardial Disease, Medical management, NOS
- Pericardial Disease, Medical management, Systemic steroid therapy
- Pericardial Disease, Medical management, Systemic nonsteroidal antiinflammatory therapy
- Pericardial Disease, Medical management, Systemic chemotherapy
- Pericardial Disease, Medical management, Local instillation of chemotherapeutic agent
- Pericardial Disease, Medical management, Radiation therapy
Pericardial disease treatment hierarchy level 4
- Pericardial disease, NOS
- Pericardial disease, Pericardial biopsy, NOS
- Pericardial disease, Pericardial biopsy, Incisional
- Pericardial disease, Pericardial biopsy, Excisional
- Pericardial disease, Pericardial drainage, NOS
- Pericardial disease, Pericardial drainage, Pericardiocentesis, NOS
- Pericardial disease, Pericardial drainage, Pericardiocentesis, Initial
- Pericardial disease, Pericardial drainage, Pericardiocentesis, Subsequent
- Pericardial disease, Pericardial drainage, Pericardiostomy tube
- Pericardial disease, Pericardial drainage, Pericardial window, NOS
- Pericardial disease, Pericardial drainage, Pericardial window, Subxiphoid
- Pericardial disease, Pericardial drainage, Pericardial window, Thoracoscopic
- Pericardial disease, Pericardial drainage, Pericardial window, Thoracoscopic—left
- Pericardial disease, Pericardial drainage, Pericardial window, Thoracoscopic—right
- Pericardial disease, Pericardial drainage, Pericardial window, Transthoracic
- Pericardial disease, Pericardial drainage, Pericardial window, Transthoracic—left
- Pericardial disease, Pericardial drainage, Pericardial window, Transthoracic—right
- Pericardial disease, Pericardial drainage, Open pericardial drainage (pericardiotomy)
- Pericardial disease, Pericardiectomy, NOS
- Pericardial disease, Pericardiectomy, Median sternotomy without cardiopulmonary bypass
- Pericardial disease, Pericardiectomy, Median sternotomy with cardiopulmonary bypass
- Pericardial disease, Pericardiectomy, Thoracotomy without cardiopulmonary bypass
- Pericardial disease, Pericardiectomy, Thoracotomy with cardiopulmonary bypass
- Pericardial disease, Pericardiectomy, Thoracoscopic
- Pericardial disease, Mass excision, NOS
- Pericardial disease, Mass excision, Debulking
- Pericardial disease, Mass excision, Complete excision
- Pericardial disease, Cyst excision
- Pericardial disease, Pericardial reconstruction for congenital absence, NOS
- Pericardial disease, Pericardial reconstruction for congenital absence, Open completion pericardial resection
- Pericardial disease, Pericardial reconstruction for congenital absence, Open with pericardial patch
- Pericardial disease, Pericardial reconstruction for congenital absence, Open with prosthetic patch
- Pericardial disease, Pericardial reconstruction for congenital absence, Thoracoscopic completion pericardial resection
- Pericardial disease, Pericardial reconstruction for congenital absence, Thoracoscopic pericardial patch
- Pericardial disease, Pericardial reconstruction for congenital absence, Thoracoscopic prosthetic patch
- Pericardial disease, Medical management, NOS
- Pericardial disease, Medical management, Systemic steroid therapy
- Pericardial disease, Medical management, Systemic nonsteroidal antiinflammatory therapy
- Pericardial disease, Medical management, Systemic chemotherapy
- Pericardial disease, Medical management, Local instillation of chemotherapeutic agent
- Pericardial disease, Medical management, Radiation therapy
IV. Diagnosis and procedure short lists
- Diagnosis Short List
- Pericardial effusion
- Pericarditis
- Pericardial disease, other
- Procedure Short List
- Pericardial drainage procedure
- Pericardiectomy
- Pericardial procedure, other
References
-
Harken A.H., Hammond G.L., Edmund L.H., Jr Pericardial diseases. In: Edmunds L.H., Jr, ed. Cardiac surgery in the adult. New York: McGraw-Hill, 1997:1303-1308.
-
Harken A.H., Hall A.W., Hammond G.L. The pericardium. In: Baue A.E., ed. Glenn’s thoracic and cardiovascular surgery. Stamford: Appleton and Lange, 1996:2299-2310.
-
Kirklin J.W., Barratt-Boyes B.G. Pericardial disease. In: Kirklin J.W., Barratt-Boyes B.G., eds. Cardiac surgery. New York: Churchill Livingstone, 1993:1683-1700.
-
Permanyer-Miralda G., Sagrista-Sauleda J., Soler-Soler J. Primary acute pericardial disease. Am J Cardiol 1985;56:623-630.[Medline]
-
Van Son J.A.M., Danielson G.K., Schaff H.V., et al. Congenital partial and complete absence of the pericardium. Mayo Clin Proc 1993;68:743-747.[Medline]
