AN IMMUNOLOGICAL APPROACH TO POSTPERICARDIOTOMY-SYNDROME OCCURRENCE AND ITS RELATION WITH AUTOIMMUNITY

Objective: An autoimmunological approach to the pathogenesis of post-p ericardiotomy syndrome. Methods In 100 consecutive patients, after ope n heart surgery, postpericardiotomy syndrome (PPS) was diagnosed in 15 patients according to clinical and laboratory criteria. These patient s were prospectively followed up. Levels of serum autoantibodies again st 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 stai ning, were taken as substrate. PPS occurrence was determined according to strongly positive antibody titers on the 14th and 21st day postope ratively. Results: CMA were positive in 18 patients, and 14 of them sh owed clinical signs of PPS. In one case PPS was apparent clinically al though CMA were not detected. There was a significant difference betwe en CMA positive and CMA negative patients on the occurrence of PPS. Wi th the use of monoclonal antihuman IgG in the conjugate of indirect fl uorescent antibody test the specificity was enhanced. Also, in our exp erience, the length of cardiopulmonary bypass (CPB) time was an import ant factor affecting the development of PPS. Conclusion : In this stud y, we found a positive correlation between the presence of CMA and PPS , which is a practical, secure and cheap criterion for the diagnosis.