Clinical studyPostcardiotomy syndrome in patients with rheumatic heart disease: Cortisone as a prophylactic and therapeutic agent☆

1. 1. The syndrome herein referred to as the postcardiotomy syndrome in patients with rheumatic heart disease was observed in thirty-three (39 per cent) of eighty-four patients with rheumatic heart disease at variable intervals after mitral valvuloplasty. This complication is usually characterized by fever and chest pain of a pleuropericardial nature, occasionally accompanied by congestive heart failure, pleural effusion, polyarthritis, arrhythmia, abdominal pain, and subcutaneous nodules. 2. 2. This syndrome has been variously called “postcommissurotomy syndrome,” “reactivation of rheumatic fever following mitral commissurotomy,” and “postvalvulotomy syndrome.” The designation “postcardiotomy syndrome in patients with rheumatic heart disease” would seem to be preferable because the syndrome was observed in a patient in whom only cardiotomy was performed due to technical difficulties; it would seem, therefore, that mitral commissurotomy is not necessary for its development. 3. 3. Cortisone had a definite suppressive effect on the syndrome. The incidence of postcardiotomy syndrome was 31 per cent in patients not receiving prophylactic cortisone and 7 per cent in the patients in the group receiving hormone prophylaxis. The immediate postoperative course of patients who received prophylactic cortisone was less stormy than that of those who did not. As a therapeutic agent, cortisone was superior to salicylates, pyramidon and antibiotics which did not favorably affect the clinical manifestations of the postcardiotomy syndrome. Cortisone in doses varying from 50 to 300 mg. daily, depending upon the person, caused a dramatic remission of symptoms and fever in the post-cardiotomy syndrome. 4. 4. It is recommended that ACTH be given prophylactically for two days preoperatively and for eight to ten days postoperatively in patients undergoing rheumatic mitral valvuloplasty.