An immunological approach to postpericardiotomy syndrome occurrence and its relation with autoimmunity.
OBJECTIVE
An autoimmunological approach to the pathogenesis of post-pericardiotomy syndrome.


METHODS
In 100 consecutive patients, after open heart surgery, postpericardiotomy syndrome (PPS) was diagnosed in 15 patients according to clinical and laboratory criteria. These patients were prospectively followed up. Levels of serum autoantibodies against cardiac muscle antigen were studied on the 14th, 21st and 33rd day postoperatively. In order to evaluate the cardiac muscle antibody (CMA), antigenic tissue sections from primate heart tissue in solid phase with intermyofibrillar and sarcolemmal-subsarcolemmal fluorescent staining, were taken as substrate. PPS occurrence was determined according to strongly positive antibody titers on the 14th and 21st day postoperatively.


RESULTS
CMA were positive in 18 patients, and 14 of them showed clinical signs of PPS. In one case PPS was apparent clinically although CMA were not detected. There was a significant difference between CMA positive and CMA negative patients on the occurrence of PPS. With the use of monoclonal antihuman IgG in the conjugate of indirect fluorescent antibody test the specificity was enhanced. Also, in our experience, the length of cardiopulmonary bypass (CPB) time was an important factor affecting the development of PPS.


CONCLUSIONS
In this study, we found a positive correlation between the presence of CMA and PPS, which is a practical, secure and cheap criterion for the diagnosis.
Kocazeybek
B
B
Institute of Cardiology, University of Istanbul, Turkey.
Erentürk
S
S
Calýk
M K
MK
Babacan
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000097:blood / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D016650:Fluorescein-5-isothiocyanate; D019084:Fluorescent Antibody Technique, Indirect; D005456:Fluorescent Dyes; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000276:immunology; D009210:Myofibrils / Q000276:immunology; D011185:Postpericardiotomy Syndrome / Q000097:blood / Q000276:immunology*; D011446:Prospective Studies; D012449:Safety; D012508:Sarcolemma / Q000276:immunology; D012680:Sensitivity and Specificity; D013997:Time Factors
D000911:Antibodies, Monoclonal; D001323:Autoantibodies; D005456:Fluorescent Dyes; D007074:Immunoglobulin G; D016650:Fluorescein-5-isothiocyanate