The clinical significance of the reoxygenation injury in pediatric heart surgery.

Significant advances have been made in the technical performance of operations for infants and neonates with congenital heart disease. However, postoperative organ dysfunction is a frequent problem, particularly in hypoxic (cyanotic) infants. We review both our experimental and subsequent clinical experience with the injury caused by abrupt reoxygenation of the hypoxic patient and examine the modalities of gradual reoxygenation and leukodepletion in limiting this injury, thereby improving operative outcomes for cyanotic lesions. As a result of our experimental and clinical experience we conclude that: (1). reoxygenation injury is a real source of postoperative cardiac and pulmonary dysfunction; (2). white blood cells play an integral role in the production of oxygen-free radicals that are responsible for the damage; and (3). this injury can be modified and possibly ameliorated by changes in the intraoperative management of cardiopulmonary bypass.