In neonatal pulmonary hypertension, the pulmonary arteries fail to adapt to extrauterine life and remain thick walled. In a previous study on normal neonatal resistance arteries, perfusion myography and confocal microscopy showed that responses to agonist stimulation were related to wall structure. We hypothesized that in hypertensive resistance pulmonary arteries, an enhanced response to contractile and relaxant agonist stimulation would be associated with an increased wall thickness and abnormal postnatal cytoskeletal remodeling of smooth muscle cells (SMC). Pulmonary arteries (110 -140 m external diameter) from normal piglets and those exposed to chronic hypobaric hypoxia from birth or from 3 d of age were mounted on a perfusion myograph. Lumen diameter and SMC nuclear positions were tracked after addition of KCl, the thromboxane mimetic U46619, and bradykinin. After fixation in situ, SMC dimensions were measured using confocal and electron microscopy. In all hypertensive animals, wall thickness and SMC density were increased and SMC length/width ratio decreased.After hypoxic exposure for 3 d, arteries from animals exposed from birth showed a greater and faster contractile response than controls, but arteries from piglets first exposed at 3 d of age did not, though both showed similar structural appearance. Increase of exposure to 11 d elicited an enhanced response and further cytoskeletal remodeling. All vessels relaxed fully to bradykinin. SMC remodeling and reactivity appear to be influenced by the age at onset and the duration of the hypoxic insult. Rapid structural and functional changes occur in the pulmonary arteries as pulmonary vascular resistance decreases after birth (1). Thick-walled fetal arteries remodel to thin-walled structures within days of birth (2). Using perfusion myography in conjunction with confocal microscopy we found that postnatal elongation of SMC within resistance arteries was associated with a decrease in the speed and extent of vessel constriction in response to agonist stimulation (3).Structural studies on the pulmonary vessels of babies with PPHN and in piglets with experimental PPHN (4 -6) show an increase in pulmonary artery medial thickness and the maturation of SMC in normally nonmuscular precapillary vessels (6). Whereas babies with PPHN appear to have an excessively reactive pulmonary arterial circulation, pharmacological studies on conduit arteries from pulmonary hypertensive piglets showed that there was no increase in the contractile response to potassium chloride (KCl), PGF2␣, or U46619, although the relaxation response to acetylcholine was impaired (7,8). We believed that the resistance pulmonary arteries would show an enhanced response to contractile stimulation, and that the response would be related to the structural abnormalities.In the present study, we hypothesized that the SMC in the thickened wall of resistance arteries from pulmonary hypertensive piglets would show an increase in myofilaments and abnormal cytoskeletal organization in association with an enh...