The significance of anticardiolipin antibodies and anti-heart muscle antibodies for the diagnosis of postpericardiotomy syndrome

Abstract

Postpericardiotomy syndrome (PPS) is a frequent complication after cardiac surgery. In a recent study, elevated anticardiolipin antibody (ACLA) titres were observed in patients with PPS. The value of anti-heart muscle antibodies (AHA) for the diagnosis of PPS remains controversial. Therefore, a prospective double-blind study was performed to test the sensitivity and specificity of ACLA and AHA for the diagnosis of PPS. ACLA titres (ELISA) and AHA, elevated by immunofluorescence, the clinical course and routine laboratory parameters were assessed in 57 patients before and after elective cardiac surgery. ACLA increased and AHA first appeared after surgery in patients both with and without PPS. The sensitivities of a > or = 1.5-fold increase in IgM-ACLA titres, of a > or = 2-fold increase in IgG-ACLA titres and of the occurrence of AHA > or = 2+ for the diagnosis of PPS were 60%, 20% and 20%. The respective specificities were 43%, 79% and 85%. Thus, after cardiac surgery, increased ACLA titres and the occurrence of AHA, as assessed by immunofluorescence, may only contribute to the diagnosis of PPS to a limited extent.

Postpericardiotomy syndrome after minimally invasive repair of pectus excavatum

“…6 The latency from pericardial injury to the clinical onset of symptoms and the usually good response to antiinflammatory therapy support this hypothesis. 6,7 Delayed manifestation of pericarditis occurs after open cardiac surgery and also after chest trauma. 6-8 Nomura et al 8 showed that there is no correlation between the extent of injury caused by a heart operation and PS.…”

“…9 The significance of antiheart muscle antibodies (AHA) in the diagnosis of PS remains controversial because even severe PS without occurrence of AHA has been described. 7 Because of similar clinical symptoms, relevant differential diagnoses of PS include pneumonia, pleuritis after chest tube placement, atelectasis, viral or bacterial endocarditis, and deep wound infection. 10 As reported recently, 3 PS did not occur when the Lorenz introducer was used.…”

Postpericardial Injury Syndrome: An Autoimmune Phenomenon

“…Levels of a variety of both heart-and non-organ-specific antibody levels prior to and following cardiac surgery were detected [5]. It has been shown that anti-sarcolemma antibodies to both heart and skeletal muscle, antiendothelial antibodies, anti-smooth muscle antibodies, and anti-nuclear antibodies (ANA) appeared more often in patients with PPIS.…”

Post-cardiac injury syndrome following transvenous pacemaker insertion: A case report and review of the literature

“…Therefore, the pathogenesis of this syndrome may involve endocardial surface injury. In addition, small contained perforations could cause an immune response and sterile inflammation in both the pericardium and the pleural space [2,14]. Hence, subacute perforation causing epicardial injury may also play a significant role in the development of this syndrome.…”