REPERFUSION INJURY - A REVIEW OF THE PATHOPHYSIOLOGY, CLINICAL MANIFESTATIONS AND THERAPEUTIC OPTIONS

Lack of blood supply or ischaemia underlies many of the most important cardiovascular and cerebrovascular diseases faced by clinicians in th eir daily practice. Many of these ischaemic episodes can be reversed a t an early stage by surgical or pharmacological means with the ultimat e aim of preventing infarction and cell necrosis in the ischaemic tiss ues. However, reperfusion of ischaemic areas, in particular the readmi ssion of oxygen, may contribute to further tissue damage (reperfusion injury). For example, the use of thrombolytic therapy in acute myocard ial infarction and other revascularisation procedures, such as percuta neous transluminal angioplasty and coronary artery bypass surgery, may be associated with reperfusion of ischaemic myocardium. Such ischaemi a and reperfusion may result in injury to one of more of the biochemic al, cellular and microvascular components of the heart. Our understand ing of the significance of reperfusion injury is however restricted by the profuse literature in animal models and limited literature in the clinical situation. This article reviews the pathophysiology, clinica l manifestations of reperfusion injury to the heart and discusses the possible therapeutic approaches to avoiding any adverse effects. Copyr ight (C) 1997 Elsevier Science Ireland Ltd.