Kassanoff A H, Martirossian M G
Department of Medicine, Presbyterian Hospital of Dallas.
Chest. 1991 Jun;99(6):1410-4. doi: 10.1378/chest.99.6.1410.
Three cases are reported that describe acute pulmonary edema as an early manifestation of a postpericardiotomy or postmyocardial infarction syndrome. Each of these cases occurred in the presence of good left ventricular function. The cases suggest this syndrome occurs in immunologically primed patients who have had prior cardiac injury resulting in readily available heart antibody. The first report followed an acute myocardial infarction that required a temporary pacemaker, and the two other cases occurred following coronary artery bypass surgery. Two of the patients had a history of distant myocardial or pericardial injury, and the third patient had an acute anteroseptal myocardial infarction two to three weeks before cardiac surgery. All three patients with pulmonary edema responded dramatically to corticosteroids, having been resistant to diuretic and pre-load and afterload reduction therapy, suggesting an autoimmune capillary injury process. Early recognition of such a syndrome is important since all three patients were successfully treated, and might otherwise have been confused with other causes of pulmonary edema.
本文报告了3例病例，这些病例将急性肺水肿描述为心包切开术后或心肌梗死后综合征的早期表现。每例病例均发生于左心室功能良好的情况下。这些病例提示，该综合征发生于有免疫致敏的患者，这些患者既往有心脏损伤，导致易于获得心脏抗体。第一例报告发生在1例需要临时起搏器的急性心肌梗死后，另外2例发生在冠状动脉搭桥手术后。2例患者有既往心肌或心包损伤史，第3例患者在心脏手术前2至3周发生急性前间隔心肌梗死。所有3例肺水肿患者对皮质类固醇均有显著反应，对利尿剂以及降低前负荷和后负荷的治疗均无效，提示存在自身免疫性毛细血管损伤过程。早期识别这种综合征很重要，因为所有3例患者均成功治愈，否则可能会与肺水肿的其他病因相混淆。
