A Postpericardiotomy and Postmyocardiai Infarction Syndrome Presenting as Noncardiac Pulmonary Edema

In the June 1991 issue of Chest, Kassanoff and Martirossian’ reported three cases of acute pulmonary edema, which, as they indicate, probably represented an autoimmune response associated with abnormal capillary permeability. Their valuable report should be further clarified. First, since diastolic ventricular function was not measured, it may he incorrect to conclude that these were cases of ‘acute pulmonary edema within two to three days after cardiac injury that could not he ascribed to impaired ventricular function.’ Ventricular function, taken as a whole, must be measured as a whole; the measures like hemodynamics and ejection fraction are incomplete descriptors. Second, I am curious about the title of the article and some of the discussion. This syndrome, which appears to be unique, is described in the title as “Postpericardiotomy and Postmyocardial Infarction Syndrome” with no basis other than a possible autoimmune response following cardiac injury with elevated sedimentation rates. To avoid misleading readers, perhaps they should have called their report something like “A Postmyocardial Injury Syndrome.” That would avoid implying that this form of pulmonary edema is a component of what Dressier described (now quite rare) and what Engle and colleagues (cited by the authors) have carefully investigated two classic syndromes that include some element of active pericardial involvement, conspicuously lacking in these three fascinating patients. These remarks are made for clarification, rather than in criticism, ofa very valuable report.