Utilidad del bloqueo de interleucina 1 con anakinra en el síndrome pospericardiotomía refractario / Usefulness of interleukin 1 receptor antagonist (anakinra) in refractory post-pericardiotomy syndrome

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Postcardiac injury syndrome.

A 58-year-old man had undergone 2-vessel off-pump coronary artery bypass surgery (OPCAB), 1 month before he was admitted into the hospital with cardiac tamponade due to pericarditis. Postcardiac injury syndrome (PCIS) was diagnosed. In spite of receiving anti-inflammatory treatment, the patient developed relapsing PCIS.

Pathologic findings in postcardiotomy patients managed with a temporary left ventricular assist pump.

Twenty-one postcardiotomy patients in cardiogenic shock, nonresponsive to pressors and intraaortic balloon, received temporary support with a pneumatically driven left ventricular assist pump, according to a strict National Institutes of Health protocol. Nine patients showed hemodynamic improvement after 91 to 190 hours; at least several of these patients had significant perioperative myocardial necrosis. Three patients remain well 39, 38 and 33 months after resuscitation. Eight of the patients died from hemorrhagic diathesis related to extended cardiopulmonary bypass times before hemodynamic improvement on left ventricular assist pump could be demonstrated. Correlation of myocardial biopsies taken at pump implantation in 15 patients and autopsy findings in nonsurvivors suggest that myocardial dysfunction has a reversible component that is related either to diminished compliance (probably due to edema) or to severe but reversible ischemic myocardial injury, or both. There was no evidence of thrombo- or biomaterials emboli or other pump-related complications.

Clinical significance of immunopathological findings in patients with post-pericardiotomy syndrome. II. The significance of serum inhibition and rosette inhibitory factors.

Serum inhibition factors (SIF) that suppress phytohaemagglutinin-induced blast transformation of normal lymphocytes, and lymphocyte E-rosette inhibitory factors (RIF) that inhibit the T cell-specific property of E-rosette formation were determined in sixty-five patients before and after cardiac surgery. SIF was found in the first post-operative week in almost all patients; patients with complete post-pericardiotomy syndrome (PPS) still had these factors in the fourth postoperative week. The appearance of SIF correlated well with the intensity of the PPS. Persistence of SIF in eleven out of eighteen patients with clinically incomplete PPS reaffirms the probability that they had an 'immunologically' positive PPS. RIF was to be found in one third of the patients with complete or incomplete PPS and may be of prognostic value. The two factors were not identical.