Central hemodynamics were examined in 50 patients with chronic obstructive bronchopulmonary disease at rest and during mild steady-state supine exercise. The cardiac output rose proportionally to increased oxygen uptake in most cases; there was no difference between the patients with and without chronic right heart failure (RHF). The mean pulmonary arterial pressure in exercise increased disproportionally to cardiac output in about half of the compensated patients and in all cases with RHF. The pulmonary vascular resistance did not change significantly. The right ventricular end-diastolic pressure (RVEDP) at rest was significantly higher in the patients with RHF than in the other but the individual variations were large. Thus, the resting RVEDP cannot be considered as a reliable sign of RV functional abnormality in individual cases. Better agreement with clinical classification of the patients was obtained when considering the exercise values of RVEDP and particularly the relation of RVEDP to stroke volume during exercise.

The authors present an account of the preoperative cardiopulmonary examination and on postoperative changes in 77 patients with bronchogenic cancer subjected to radical surgical treatment. Twenty-three of them were older than 65 years. The results of ventilation tests do not differ significantly from those in younger patients; the older patients show only a tendency to higher residual volume and a less favourable ratio between alveolar and total ventilation than younger individuals. In the blood gases and hemodynamic values no significant differences were revealed. The mortality during the initial postoperative period and within six months after operation is not higher in patients over 65 years that in the other groups. The postoperative changes are approximately equal in all age groups. In the older patients only the mean pressure in the right atrium and in pulmonary artery as well as the total pulmonary resistance rise more than in younger cases. No case of respiratory acidosis or right heart failure was recorded.The authors conclude that the age of the patients is not decisive for the indication of radical surgical therapy of bronchogenic cancer and only the preoperative assessement of cardiopulmonary function is important, whereby in older age groups an approximately equal development of postoperative functional changes as in younger groups may be expected.Relative contraindications of more extensive lung resections for bronchogenic cancer include also the advanced age of the patients. The conception of advanced age is, however, usually not specified; the majority of authors agree that the decisive criterion for surgical therapy is the cardiopulmonary function and not advanced age alone. Nevertheless, many authors are rather reserved concerning indication in patients 60-70 years of age.

An ideal vasodilator should be selective for the pulmonary vascular bed, thus minimizing side-effects from reduced systemic resistance. It must achieve not only a drop in pulmonary vascular resistance but also a marked decrease in pulmonary arterial pressure. The ideal drug should increase cardiac output and pulmonary venous oxygen saturation. An increase in oxygen delivery to the peripheral tissues should be achieved at a lower right ventricular afterload both at rest and during exercise. Right ventricular function should be improved. The effects of vasodilator therapy should be so marked that it should be possible to follow them non-invasively by radionuclide methods and exercise tolerance tests. The aim of vasodilator therapy is a regression of pulmonary hypertension and of right ventricular hypertrophy, an improved quality of life, and above all a longer survival.

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