Studies on Anomalous Collateral Systemic-Pulmonary Circulation

Abstract

SUMMARYThe circulatory status of four patients with anomalous systemic-pulmonary circulations has been studied by bronchospirometry, cardiac catheterization, angiography, and dyedilution techniques. In three of these patients the affected lung was smaller than normal, and bronchography showed no abnormalities. On the affected side angiography failed to show filling of the pulmonary artery, and the oxygen uptake appeared to be zero or minimal. In two of the patients bronchospirometry revealed an effective collateral circulation, whereas the dye-dilution curves were almost normal. In the other patient there was anatomic evidence of both transpleural systemic-pulmonary arterial communication and occlusive disease of the pulmonary veins. Here the dye-dilution curves revealed considerable shunting of blood, whereas no effective collateral circulation could be demonstrated. The fourth patient has extensive unilateral bronchiectasis and illustrates the condition wherein neither pulmonary nor systemic blood flows through the pulmonary capillary bed.The pathogenesis of the various pathways of collateral circulation is discussed, as well as some methodological and technical problems. ADDITIONAL INDEXING WORDS:Bronchopulmonary circulation Obstruction of pulmonary veins Bronochospirometry IN RECENT YEARS the number of reports on anomalous systemic-pulmonary circulation has steadily increased, and several aspects of anatomic and functional pathology have been studied.'-6 Anomalous communications between bronchial and pulmonary circulation have been described in organizing pulmonary disease,6-1" congenital atresia, or acquired obliteration of the pulmonary artery.12-5 As not only bronchial vessels, but also other systemic arteries may be involved,16 17 the diagnostic label has been appropriately changed from collateral bronchopulmonary circulation to collateral systemic-pulmonary circulation.

Shunts in and over the Lungs

“…In this way the total right-to-left shunt, including the physiol ogic shunt, can be estimated. The estimation of the oxygen saturation of (2) The right heart catheterisation technique is of importance in dem onstrating left-to-right shunts type I and II (see 1) [29,38,39,48]. Careful registration of the pressure curves and the oxygen saturation as well as the scrupulous analysis of the catheter route is of great help in detecting anomalous debouching pulmonary veins as well as anomalous intercostal and mammarial arteries.…”

“…Careful registration of the pressure curves and the oxygen saturation as well as the scrupulous analysis of the catheter route is of great help in detecting anomalous debouching pulmonary veins as well as anomalous intercostal and mammarial arteries. At the same time the hydrogen elec trode technique (see 7) may also be useful in detecting similar bypasses [12,27], (3) Broncho-spirometric techniques are especially of interest in case of restricted or absent flow through a main pulmonary artery [30,48]. If at the affected side no oxygen uptake is found, the cause may be ei ther compression from outside or ingrowth or thrombosis of the vascular lumen.…”

Unilateral congenital dysplasia of lung associated with vascular anomalies

“…In a second case they described fibrosed alveolar walls and 'hypoplastic muscle. ' The detailed macroscopic distribution of the blood vessels has been described only once (Tammeling, Nieveen, and Sluiter, 1967). In this case at necropsy all vascular systems were injected and no pulmonary artery was found, but there was a normal pulmonary venous return and, at the hilum, anastomoses between branches from the internal mammary artery and thinwalled pulmonary arteries that were distributed with airways.…”