The vasoconstrictive action of norepinephrine on the pulmonary vessels has been consistently demonstrated in animals by histological techniques (Patel and Burton, 1957) or by preparations in which pulmonary blood flow could be regulated at will and continuously measured (Rose et al., 1955;Borst, Berglund, and McGregor, 1957;Eliakim and Aviado, 1961); but such techniques are not applicable in man. Pulmonary vasoconstriction following the administration of norepinephrine has not been demonstrated unequivocally in man; although Patel, Lange, and Hecht (1958) reported significant increases of pulmonary vascular resistance during steady-state administration of norepinephrine and interpreted this as indicating pulmonary arteriolar constriction, Fowler et al. (1951) under similar conditions obtained no such increase. Investigating the effect of norepinephrine on the pulmonary circulation in a group of patients with aortic regurgitation, Regan et al. (1959) found no change in pulmonary vascular resistance, whereas an increase was noted in their normal controls. In view of these contradictory reports further investigation of the subject was undertaken.
MATERIAL AND METHODSThe study was carried out in two parts. In 13 subjects (group A) "steady-state" observations of pressures and blood flow in the pulmonary circulation were made before and during infusion of norepinephrine: pulmonary vascular resistance was thus computed. In 9 additional subjects (group B) the moment-to-moment changes of pressure across the pulmonary vascular bed were observed, following a single injection of norepinephrine. While flow, and thus resistance, changes could not be measured by this method, rapid transients that would not be discernible by the "steady-state" method could be observed.Group A. In this group there were 6 patients with isolated pulmonary stenosis, 1 with atrial septal defect, 3 with small ventricular septal defect, and 2 others, one of whom had been in heart failure three years before after an infundibular resection for the tetralogy of Fallot. There was also one person investigated for a praecordial systolic murmur, in whom no hlmodynamic abnormality was found. All subjects were familiar with the laboratory surroundings and had practised breathing through the mouthpiece of the close-circuit spirometer which measured the oxygen consumption. Right heart catheterization was performed with the subjects mildly sedated and in the post-absorptive state: single lumen, end-hole catheters were introduced from a medial antecubital vein and in each case the diagnostic data were first collected. For the observations control blood samples, oxygen consumption, and pressures were obtained, and this was followed by intravenous administration of norepinephrine at a concentration of 8 ,ug./ml. in isotonic saline. The rate of administration was adjusted to produce stable systemic hypertension of moderate degree; and the amount thus given