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

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) ( = 19) with all three symptoms; (2) incomplete PPS with two symptoms ( = 18); and (3) no PPS with one or no symtpoms ( = 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.