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Pulmonary reperfusion injury in post-palliative intervention of oligaemic cyanotic CHD: a new catastrophic consequence or just revisiting the same old story?

Published online by Cambridge University Press:  18 October 2023

Sisca Natalia Siagian Open the ORCID record for Sisca Natalia Siagian [Opens in a new window] ,
Made Satria Yudha Dewangga ,
Bayushi Eka Putra Open the ORCID record for Bayushi Eka Putra [Opens in a new window]  and
Christianto Christianto Open the ORCID record for Christianto Christianto [Opens in a new window]
Sisca Natalia Siagian
Affiliation:
Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
Made Satria Yudha Dewangga
Affiliation:
Department of Cardiology and Vascular Medicine, Sanglah General Hospital, Denpasar, Indonesia
Bayushi Eka Putra
Affiliation:
Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
Christianto Christianto*
Affiliation:
Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
*
Corresponding author: C. Christianto; Email: chriz88to@gmail.com
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Abstract

Pulmonary reperfusion injury is a well-recognised clinical entity in the setting pulmonary artery angioplasty for pulmonary artery stenosis or chronic thromboembolic disease, but not much is known about this complication in post-palliative intervention of oligaemic cyanotic CHD. The pathophysiology of pulmonary reperfusion injury in this population consists of both ischaemic and reperfusion injury, mainly resulting in oxidative stress from reactive oxygen species generation, followed by endothelial dysfunction, and cytokine storm that may induce multiple organ dysfunction. Other mechanisms of pulmonary reperfusion injury are “no-reflow” phenomenon, overcirculation from high pressure in pulmonary artery, and increased left ventricular end-diastolic pressure. Chronic hypoxia in cyanotic CHD eventually depletes endogenous antioxidant and increased the risk of pulmonary reperfusion injury, thus becoming a concern for palliative interventions in the oligaemic subgroup. The incidence of pulmonary reperfusion injury varies depending on multifactors. Despite its inconsistence occurrence, pulmonary reperfusion injury does occur and may lead to morbidity and mortality in this population. The current management of pulmonary reperfusion injury is supportive therapy to prevent deterioration of lung injury. Therefore, a general consensus on pulmonary reperfusion injury is necessary for the diagnosis and management of this complication as well as further studies to establish the use of novel and potential therapies for pulmonary reperfusion injury.

Keywords

Pulmonary reperfusion injurypalliative interventioncyanotic CHD
Type
Review
Information
Cardiology in the Young , Volume 33 , Issue 11 , November 2023 , pp. 2148 - 2156
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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