Chronic Thromboembolic Pulmonary Hypertension Clinical Trial
Official title:
N-acetyl Cysteine in Post-reperfusion Pulmonary Injury in Patients With Chronic Thromboembolic Pulmonary Hypertension Undergoing Pulmonary Balloon Angioplasty and Pulmonary Endarterectomy.
This study will evaluate the use of N-acetyl cysteine in post-reperfusion pulmonary injury in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary balloon angioplasty and pulmonary endarterectomy. Half of the patients will receive N-acetyl cysteine and the other placebo.
For chronic pulmonary embolism thrombus hypertension, the potentially curative treatment is
endarterectomy, however in 12 to 60% it does not present surgical susceptibility, so
pulmonary balloon angioplasty is the secondary option. In these procedures the complication
that occurs most frequently is pulmonary oedema after reperfusion is a frequent complication
(17.8-65%), appears between 24-72 hours after the intervention and the diagnosis is made in
the presence of infiltrate interstitial in chest radiography or computed tomography of the
chest. Initially it was believed that it was difficult due to the increase in perfusion of
secondary flow in the territory due to pulmonary vascular dilation, it is now believed that
microtraumatism is involved by the guides and balloon used, vascular dysfunction and
cytokines and innate immunity and adaptive, complement activation, coagulation cascade
activation, apoptosis pathway activation, endothelial dysfunction caused by reperfusion
contribute to cell dysfunction.
The use of N-acetyl cysteine for its antioxidant properties, inflammatory response
attenuator, reduction of reactive oxygen species (ROS) and that in addition to having already
had to reduce the condition of decrease in post-reperfusion ischemia15,16 in other situations
is a viable option in the treatment of acute post-reperfusion edema in patients sometimes a
pulmonary endarterectomy and balloon pulmonary angioplasty.
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