[Changes in immunologic parameters following heart operations with special reference to the postcardiotomy syndrome]

In 29 patients (twelve female, 17 male) the following immunologic parameters were examined before and between days 1 to 3, 6 to 8, 13 to 15 and 20 to 22 after open-heart surgery: T-lymphocytes; immunoglobulins IgG, IgM, IgA, IgE; complement factors C3, C4 and the autoantibodies (Anti-DNA, myocardial antibodies, SMA, ANA, AMA) to assess changes in these parameters and their relationship to postoperative complications, in particular post-cardiotomy-syndrome (PCS). PCS was found in five patients (17.2%), in three fully developed, in two in a partial form. In the very early (first to third day) postoperative course, significant suppression of most parameters was found, most likely due to tissue traumatization intraoperatively as well as to the extracorporeal circulation. There was suppression of T-lymphocytes, immunoglobulins IgG, IgM and IgA and the complement factors C3 and C4. The IgE rose slightly. The serum IgM level appears to be of prognostic relevance since the patients with IgM suppression had a higher incidence of postoperative complications (PCS, pancreatitis). In the later postoperative course IgM, C3 and C4 significantly exceeded the preoperative values. The rise in IgM can be explained as an immunologic answer to a subclinical infection or to an immunization by autoantigenic tissue. The rise in C3 and C4 was interpreted as an acute phase reaction. These changes, however, had no influence on the postoperative course of the autoantibodies, only subsarcolemmal myocardial antibodies were found preoperatively; in four of the five patients with PCS, these myocardial antibodies were present prior to surgery. Postoperative myocardial antibodies were found in 75% of the patients. In all probability they are only indicative of nonspecific myocardial lesions.