Intrapericardial treatment of persistent autoreactive pericarditis/myopericarditis and pericardial effusion.

For the quite small international group of cardiologists specializing in diseases of the pericardium, the most vexing of these is recurrent pericarditis. Virtually never due to an identifiable microorganism or systemic disease (at least after the index attack), most patients have either recurrent pericardial effusions or, more often, extremely unpleasant, disabling chest pain which nearly always yields to systemic administration of a corticosteroid, especially after failure of non-steroidal agents. This is followed by one of two courses: either recurrent pericarditis: discrete recurrences after days, weeks or months or incessant pericarditis: resistance to attempts to completely taper the corticosteroid, with symptoms repeatedly returning at each patient’s customary threshold level. The latter patients may be fairly described as ‘steroid hooked’ and have a wide variety and intensity of corticosteroid side effects making life even more unpleasant. While methods are under development to permit entering the ‘dry’ pericardium, Professor Maisch and his collaborators have had extraordinary success in managing recurrent, presumably immunopathic (autoreactive) pericardial effusions with direct intrapericardial therapy. Whereas most diagnostic evaluations of any kind of pericardial disease are limited to familiar laboratory procedures — negative results leaving a large number of bacteriologic, virologic ‘idiopathic’ cases — Maisch et al. have performed the most thorough set conceivable of hematic, chemical and immunologic tests on pericardial fluid and tissue as well as blood.