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. 1979 Nov;38(2):189–197.

Clinical significance of immunopathological findings in patients with post-pericardiotomy syndrome. I. Relevance of antibody pattern

B Maisch, P A Berg, K Kochsiek
PMCID: PMC1537862  PMID: 527258

Abstract

Sera from sixty-five patients were collected before and after cardiac surgery to determine striated muscle antibodies (anti-heart and anti-skeletal), non-organ-specific antibodies, immunoglobulin and complement levels. According to the clinical features of pericarditis, fever and leucocytosis, patients were divided into three groups: (1) complete post-pericardotomy syndrome (PPS) (n = 19) with all three symptoms; (2) incomplete PPS with two symptoms (n = 18); and (3) no PPS with one or no symtpoms (n = 28). Almost all the patients with complete PPS, two thirds of the patients with incomplete PPS and one third of the patients with no PPS showed striated muscle antibodies. Anti-sarcolemmal antibodies predominated.

In patients with complete PPS, antibodies persisted beyond the fourth post-operative week and correlated well with symptoms. An even better correlation with the syndrome could be obtained by including the post-operative occurrence of anti-endothelial (AEA), smooth muscle (SMA), the pre- and post-operative frequency of antinuclear antibodies (ANA) and the increase in immunoglobulin concentrations after surgery in an immunological grading system. These criteria permitted a redistribution of the nineteen patients with an incomplete PPS: fourteen were immunologically positive for a PPS. Although autoantibodies are predominantly associated with PPS, their role in the pathogenesis of the syndrome is not clear. The complementary influence of surgical and non-surgical factors, such as the degree of myocardial damage, the time of ischemia during the operation and a possible viral infection by blood transfusion, is analysed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BAER D. M., OSBORN J. J. The postperfusion pulmonary congestion syndrome. Am J Clin Pathol. 1960 Nov;34:442–445. doi: 10.1093/ajcp/34.5.442. [DOI] [PubMed] [Google Scholar]
  2. BERGSTROM I., DAHLSTROM G. Fever with a blood picture resembling infectious mononucleosis in operated tuberculous cases. Acta Tuberc Scand. 1957;34(1-2):132–139. [PubMed] [Google Scholar]
  3. Berg P. A., Binder T., Lindner H., Bannaski H., Maas D., Henning H., Brügel H. Heterogenität mitochondrialer Autoantikörper. Zur serologischen Diagnose der primär-biliären Zirrhose und des Pseudo-Lupus erythematodes mit Hilfe von zwei verschiedenen Antigenfraktionen. Dtsch Med Wochenschr. 1975 May 16;100(20):1123–1127. doi: 10.1055/s-0028-1106345. [DOI] [PubMed] [Google Scholar]
  4. Berg P. A., Doniach D., Roitt I. M. Mitochondrial antibodies in primary biliary cirrhosis. I. Localization of the antigen to mitochondrial membranes. J Exp Med. 1967 Aug 1;126(2):277–290. doi: 10.1084/jem.126.2.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Berg P. A. Humorale Immunphänomene bei akuter und chronishcer Virushepatitis. Immun Infekt. 1975 Aug;3(4):172–181. [PubMed] [Google Scholar]
  6. Berg P. A., Roitt I. M., Doniach D., Horne R. W. Mitochondrial antibodies in primary biliary cirrhosis. 3. Characterization of the inner-membrane complement fixing antigen. Clin Exp Immunol. 1969 May;4(5):511–525. [PMC free article] [PubMed] [Google Scholar]
  7. COONS A. H., KAPLAN M. H. Localization of antigen in tissue cells; improvements in a method for the detection of antigen by means of fluorescent antibody. J Exp Med. 1950 Jan 1;91(1):1–13. doi: 10.1084/jem.91.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. DAVIES A. M., GERY I. The role of autoantibodies in heart disease. Am Heart J. 1960 Nov;60:669–674. doi: 10.1016/0002-8703(60)90350-1. [DOI] [PubMed] [Google Scholar]
  9. DRESDALE D. T., RIPSTEIN C. B., GUZMAN S. V., GREENE M. A. Postcardiotomy syndrome in patients with rheumatic heart disease; cortisone as a prophylactic and therapeutic agent. Am J Med. 1956 Jul;21(1):57–74. doi: 10.1016/0002-9343(56)90008-0. [DOI] [PubMed] [Google Scholar]
  10. DRESSLER W. Idiopathic recurrent pericarditis; comparison with the postcommissurotomy syndrome; considerations of etiology and treatment. Am J Med. 1955 Apr;18(4):591–601. doi: 10.1016/0002-9343(55)90459-9. [DOI] [PubMed] [Google Scholar]
  11. DRUSIN L. M., ENGLE M. A., HAGSTROM J. W., SCHWARTZ M. S. THE POSTPERICARDIOTOMY SYNDROME: A SIX-YEAR EPIDEMIOLOGIC STUDY. N Engl J Med. 1965 Mar 25;272:597–602. doi: 10.1056/NEJM196503252721201. [DOI] [PubMed] [Google Scholar]
  12. Das S. K., Cassidy J. T., Petty R. E. Antibodies against heart muscle and nuclear constituents in cardiomyopathy. Am Heart J. 1972 Feb;83(2):159–166. doi: 10.1016/0002-8703(72)90134-2. [DOI] [PubMed] [Google Scholar]
  13. Das S. K., Cassidy J. T., Petty R. E. The significance of heart-reactive antibodies in heart disease. Chest. 1974 Aug;66(2):179–181. doi: 10.1378/chest.66.2.179. [DOI] [PubMed] [Google Scholar]
  14. ENGLE M. A., ITO T. The postpericardiotomy syndrome. Am J Cardiol. 1961 Jan;7:73–82. doi: 10.1016/0002-9149(61)90425-8. [DOI] [PubMed] [Google Scholar]
  15. Engle M. A., McCabe J. C., Ebert P. A., Zabriskie J. The Postpericardiotomy syndrome and antiheart antibodies. Circulation. 1974 Mar;49(3):401–406. doi: 10.1161/01.cir.49.3.401. [DOI] [PubMed] [Google Scholar]
  16. Engle M. A., Zabriskie J. B., Senterfit L. B., Ebert P. A. Postpericardiotomy syndrome. A new look at an old condition. Mod Concepts Cardiovasc Dis. 1975 Nov;44(11):59–64. [PubMed] [Google Scholar]
  17. Engle M. A., Zabriskie J. B., Senterfit L. B., Tay D. J., Ebert P. A. Immunologic and virologic studies in the postpericardiotomy syndrome. J Pediatr. 1975 Dec;87(6 Pt 2):1103–1108. doi: 10.1016/s0022-3476(75)80122-3. [DOI] [PubMed] [Google Scholar]
  18. Fowler N. O. Autoimmune heart disease. Circulation. 1971 Aug;44(2):159–162. doi: 10.1161/01.cir.44.2.159. [DOI] [PubMed] [Google Scholar]
  19. Hawkins B. R., McDonald B. L., Dawkins R. L. Characterisation of immunofluorescent heterophile antibodies which may be confused with autoantibodies. J Clin Pathol. 1977 Apr;30(4):299–307. doi: 10.1136/jcp.30.4.299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. JANTON O. H., GLOVER R. P., O'NEILL T. J. E., GREGORY J. E., FROIO G. F. Results of the surgical treatment for mitral stenosis; analysis of one hundred consecutive cases. Circulation. 1952 Sep;6(3):321–333. doi: 10.1161/01.cir.6.3.321. [DOI] [PubMed] [Google Scholar]
  21. KAPLAN M. H., MEYESERIAN M. An immunological cross-reaction between group-A streptococcal cells and human heart tissue. Lancet. 1962 Apr 7;1(7232):706–710. doi: 10.1016/s0140-6736(62)91653-7. [DOI] [PubMed] [Google Scholar]
  22. Kantor G. L., Goldberg L. S., Johnson B. L., Jr, Derechin M. M., Barnett E. V. Immunologic abnormalities induced by postperfusion cytomegalovirus infection. Ann Intern Med. 1970 Oct;73(4):553–558. doi: 10.7326/0003-4819-73-4-553. [DOI] [PubMed] [Google Scholar]
  23. Kaplan M. H., Frengley J. D. Autoimmunity to the heart in cardiac disease. Current concepts of the relation of autoimmunity to rheumatic fever, postcardiotomyand postinfarction syndromes and cardiomyopathies. Am J Cardiol. 1969 Oct;24(4):459–473. doi: 10.1016/0002-9149(69)90489-5. [DOI] [PubMed] [Google Scholar]
  24. Kloster F. E. Diagnosis and management of complications of prosthetic heart valves. Am J Cardiol. 1975 Jun;35(6):872–885. doi: 10.1016/0002-9149(75)90124-1. [DOI] [PubMed] [Google Scholar]
  25. Käriäinen L., Klemola E., Paloheimo J. Rise of cytomegalovirus antibodies in an infectious-mononucleosis-like syndrome after transfusion. Br Med J. 1966 May 21;1(5498):1270–1272. doi: 10.1136/bmj.1.5498.1270. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. LARSON D. L. Relation of the postcommissurotomy syndrome to the rheumatic state. Circulation. 1957 Feb;15(2):203–209. doi: 10.1161/01.cir.15.2.203. [DOI] [PubMed] [Google Scholar]
  27. LISAN P., REALE A., LIKOFF W. The postmitral commissurotomy syndrome: a four-year clinical, pathologic and serologic study, and its relation to restenosis. Ann Intern Med. 1959 Jun;50(6):1352–1358. doi: 10.7326/0003-4819-50-6-1352. [DOI] [PubMed] [Google Scholar]
  28. Manabe H., Shirakura R., Mori T. Cardiovascular disease and immunology in cardiac surgery. Jpn Circ J. 1975 Apr;39(4):453–458. doi: 10.1253/jcj.39.453. [DOI] [PubMed] [Google Scholar]
  29. McCabe J. C., Ebert P. A., Engle M. A., Zabriskie J. B. Circulating heart-reactive antibodies in the postpericardiotomy syndrome. J Surg Res. 1973 Feb;14(2):158–164. doi: 10.1016/0022-4804(73)90025-5. [DOI] [PubMed] [Google Scholar]
  30. McCabe J. C., Zabriskie J. B., Engle M. A., Ebert P. A. Heart-reactive antibodies following cardiac operations. Surg Forum. 1972;23(0):181–182. [PubMed] [Google Scholar]
  31. SOLOFF L. A., ZATUCHNI J., JANTON O. H., O'NEILL T. J., GLOVER R. P. Reactivation of rheumatic fever following mitral commissurotomy. Circulation. 1953 Oct;8(4):481–497. doi: 10.1161/01.cir.8.4.481. [DOI] [PubMed] [Google Scholar]
  32. VAN DER GELD H. ANTI-HEART ANTIBODIES IN THE POSTPERICARDIOTOMY AND THE POSTMYOCARDIAL-INFARCTION SYNDROMES. Lancet. 1964 Sep 19;2(7360):617–621. doi: 10.1016/s0140-6736(64)90512-4. [DOI] [PubMed] [Google Scholar]

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