Erkki Klemola

Antibody responses to the Epstein-Barr virus and cytomegaloviruses after open-heart and other surgery.

Abstract Patients undergoing heart surgery with or without extracorporeal circulation were tested for antibody responses to the Epstein-Barr virus (EBV) and cytomegalovirus (CMV) to assess the frequency of transmission of the two viruses by these procedures. Anti-EBV responses followed both extracorporeal circulation with fresh blood and transfusions of stored blood overall in 8 per cent of 229 patients. Among 18 without preoperative antibodies anti-EBV unaccompanied by overt illness developed in six. Anti-CMV responses were noted only among the 152 patients with extracorporeal circulation overall in 35 per cent and in 59 per cent of 61 patients without preoperative antibodies. Of 72 patients specially followed, 17 formed anti-CMV de novo, accompanied in four by the postperfusion syndrome. Hepatitis-associated (Australia) antigen became detectable in one of the 72 patients, the only one in whom hepatitis B developed.

Subclinical cytomegalovirus infections and cytomegalovirus mononucleosis after open heart surgery

Abstract In a series of 63 patients submitted to open heart operations in which fresh blood was used for perfusion, a significant (i.e., at least eight-fold) postoperative rise in the titer of complement-fixing antibodies to the cytomegalovirus was established in 19 cases (30 per cent). After the operation, 1 patient had a febrile syndrome with hematologic features of infectious mononucleosis but without positive findings on a heterophil agglutination test. The cytomegalovirus was isolated from the urine. The illness was considered to be a clinical manifestation of acquired cytomegalovirus infection, cytomegalovirus mononucleosis. In 18 other patients with a postoperative rise of cytomegalovirus antibody titer, no clinical disease was observed. The frequency of significant postoperative rises in the antibody titer was clearly correlated to the preoperative level of antibody titer. A significant rise was established in 10 of 17 patients (59 per cent) who had no demonstrable antibodies preoperatively, in 9 of 36 patients (25 per cent) whose preoperative titer was relatively low and in none of those with higher preoperative titers. In a control series of 60 patients submitted to other kinds of heart operations, without extra-corporeal circulation and with the use of citrated bank blood only, no significant rise of cytomegalovirus antibody titer was established in any patient. The transfer of the infection via fresh or relatively fresh blood, transfused in large quantities, offers the best explanation for the common occurrence of cytomegalovirus infection after open heart operations. Extracorporeal circulation may be of importance in the transmission of a new infection or reactivation of a latent infection.