Hypoxia, reoxygenation and the role of systemic leukodepletion in pediatric heart surgery.
As cardiopulmonary bypass (CPB) in infants and neonates is becoming more frequent, the technical performance of these operations for congenital heart disease has made significant progress. However, little research has been carried out into the conduct of CBP in producing myocardial and pulmonary dysfunction. Postoperative organ dysfunction is a problem, particularly for cyanotic infants. This paper examines the experimental and clinical experience of injury brought about by abrupt reoxygenation of the hypoxic, or cyanotic, heart. The modalities of gradual reoxygenation and leukodepletion in limiting this injury are examined, leading to the conclusion that injury can be reduced and possibly ameliorated by changes in intraoperative management during CBP in children with cyanotic disease.
Allen
B S
BS
Division of Cardiovascular Surgery, The Heart Institute for Children, Hope Children's Hospital, Oak Lawn, Illinois 60453, USA.
Ilbawi
M N
MN
D000818:Animals; D000831:Animals, Newborn; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods / Q000592:standards; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000592:standards*; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D007937:Leukapheresis; D010100:Oxygen / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism
D010100:Oxygen