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.
Zusammenfassung 1. Das akute Nierenversagen nach 1456 Operationen mit der Herz-Lungen-Maschine wurde im Hinblick auf Häufigkeit und Verlauf untersucht. Es trat in 43 Fällen (3 % der Gesamtzahl) auf. Andere Autoren geben eine Häufigkeit zwischen 1,8 und 5,6 % an. 2. Die Dauer der Oligurie betrug durchschnittlich 4 Tage. Zwei Patienten hatten ein NV, das mit einer Polyurie einherging. Die maximalen Harnstoffwerte i. S. schwankten zwischen 86 und 450 mg%.3. Von 43 Patienten wurden 31 dialysiert, von diesen 31 starben 24 (= 77%). Von den Nichtdialysierten starben 9 (= 75%). Die Letalität betrug insgesamt 76 %. Diese Zahl entspricht den Angaben anderer Autoren.4. Nur in 7 Fällen war das akute NV die primäre Todesursache. 20 Patienten starben infolge einer postoperativen Herz-und Kreislaufinsuffizienz, 1 Pat. infolge Leberversagens; weitere Todesursachen waren Aortennahtruptur, Staphylokokkensepsis, Exazerbation rheumatischer Endokarditis bzw. Myokarditis. 5. Ein möglicher Zusammenhang zwischen dem postoperativen NV und einem oder mehreren der folgenden Faktoren wurde diskutiert: a) präoperativ: Nierenschädigung infolge der mangelhaften kardialen Förderleistung; b) intraoperativ: Perfusionszeit, Perfusionsvolumen, arterieller Druck während der Perfusion, Hämolyse, pH-Wert, Hypothermie; c) postoperativ: durch den Eingriff bedingte Herz-und Kreislaufinsuffizienz.6. Ein Vergleich dieser Faktoren bei den 43 Pa-The causes of acute renal failure after operations with the heart-lung machine.
The incidence of acute renal failure following cardiac surgery was markedly increased during the last years in our medical center. There was no correlation to known etiologic factors such as preexisting disease, hemolysis, low perfusion rates, post-operative low output syndrome etc. Post-operative renal failure was mainly seen in children between 2 and 10 years and was noted after 3-4 days of normal renal function. Peritoneal dialysis was carried out in 39% of out patients and the overall mortality was 10.7%. Careful analysis of our cases exhibited a correlation of the post operative acute renal failure to the intravenous application of Aescin. After abandoning this drug from our post-operative therapy we did not observe a similar case since almost one year.
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