A Postpericardiotomy and Postmyocardlal Infarction Syndrome Presenting as Noncardiac Pulmonary Edema

Abstract

To the Editor:Our article was submitted with the title “A Postpericardiotomy and Postmyocardial Infarction Syndrome Presenting as Noncardiac Pulmonary Edema,” which is the way the article is listed in the table of contents. Somehow, the limiting adjective “A” was omitted from the title of the article itself. Unfortunately, I failed to make the necessary correction when I received the galley proof. The grammatical determiner “A” was intended to emphasize the point that the three cases presented a different type of postpericardial or postmyocardial infarction injury, certainly a variant from Engle's and Dressler's descriptions. Whether there is a common immunologic thread between the three entities remains to be elucidated.Dr Spodick is quite correct in emphasizing the fact that ventricular function cannot be accurately determined without diastolic ventricular function measurement. The three cases, by necessity, were evaluated at the bedside; in the first case the ejection fraction was 60 percent on echocardiogram, and in the second and third cases the postoperative left atrial pressures were normal. Thus, on the basis of the measurements available to us and therapeutic observation, we felt it reasonable to assume that the pulmonary edema was not due to congestive heart failure. Our observations do indeed need clarification through careful laboratory study, but based on our clinical observations, as Dr Spodick emphasizes, we may be dealing with an entirely different entity, probably immunologic in origin. To the Editor: Our article was submitted with the title “A Postpericardiotomy and Postmyocardial Infarction Syndrome Presenting as Noncardiac Pulmonary Edema,” which is the way the article is listed in the table of contents. Somehow, the limiting adjective “A” was omitted from the title of the article itself. Unfortunately, I failed to make the necessary correction when I received the galley proof. The grammatical determiner “A” was intended to emphasize the point that the three cases presented a different type of postpericardial or postmyocardial infarction injury, certainly a variant from Engle's and Dressler's descriptions. Whether there is a common immunologic thread between the three entities remains to be elucidated. Dr Spodick is quite correct in emphasizing the fact that ventricular function cannot be accurately determined without diastolic ventricular function measurement. The three cases, by necessity, were evaluated at the bedside; in the first case the ejection fraction was 60 percent on echocardiogram, and in the second and third cases the postoperative left atrial pressures were normal. Thus, on the basis of the measurements available to us and therapeutic observation, we felt it reasonable to assume that the pulmonary edema was not due to congestive heart failure. Our observations do indeed need clarification through careful laboratory study, but based on our clinical observations, as Dr Spodick emphasizes, we may be dealing with an entirely different entity, probably immunologic in origin. A Postpericardiotomy and Postmyocardial Infarction Syndrome Presenting as Noncardiac Pulmonary EdemaCHESTVol. 101Issue 5PreviewTo the Editor: Full-Text PDF