Endobronchial Changes in Chronic Pulmonary Venous Hypertension

doi:10.1378/chest.94.6.1127

Chest

Volume 94, Issue 6, December 1988, Pages 1127-1132

https://doi.org/10.1378/chest.94.6.1127 Get rights and content

The bronchial venous system closely communicates with the pulmonary circulation. To assess the changes in the bronchial circulation in chronic pulmonary venous hypertension, fiberoptic bonchoscopy and right heart catheterization were performed in 31 patients with mitral stenosis. Nonpulsatile submucosal vessel dilatation, consistently seen in all patients and called the vessel dilatation score, was assessed visually by three independent bronchoscopists. The vessel dilatation score was correlated more closely with pulmonary artery wedge pressure (r = 0.687) (p<0.001) than to mean pulmonary artery pressure (r = 0.531) (p<0.01) and right atrial pressure (r = 0.178) (NS). The vessel dilatation score decreased after reduction of the left atrial load by surgery. These results suggest that the dilated vessels observed in patients with mitral stenosis are bronchial veins that are engorged secondary to increased blood flow via bronchopulmonary anastomoses. (Chest 1988; 94:1127-32)

Section snippets

MATERIALS AND METHODS

Fiberoptic bronchoscopy and right heart catheterization were performed in 31 patients with mitral stenosis who showed no signs of bronchial or pulmonary complications. The fiberoptic bronchoscopes used for observation were the Olympus BF6C, Type 10, 6C10 and 1T10. After administration of 2 percent lidocaine (Xylocaine) spray to the larynx, the vessels under the bronchial mucosal membrane were observed, with care being taken not to touch the mucosa and stimulate coughing. Electrocardiographic

RESULTS

Characteristics of the patient population, right heart catheterization data and the vessel dilatation scores are summarized in Table 1. There was significant correlation between the vessel dilatation score and pulmonary artery wedge pressure (r = 0.687, s = 0.677) (p<0.001) (Fig 3, top). Good correlation also was found between the vessel dilatation score and mean pulmonary artery pressure (r = 0.531, s = 0.467) (p<0.01) (Fig 3, bottom). There was no correlation between the vessel dilatation

DISCUSSION

As shown by the results of a recent study of the bronchial circulation using soft radiographs of the lung prepared by the inflated fixation method,¹⁰ the bronchial and the pulmonary circulation systems are connected to each other via the bronchial venous plexuses.

In their experiment in dogs, Auld et al¹⁵ showed that when pulmonary venous pressure was increased, the amount of blood flow originated in the bronchial artery and returning to the pulmonary vein through the bronchial vein decreased.

REFERENCES (17)

K.K. Pump
The bronchial arteries and their anastomoses in the human lung
Dis Chest
(1963)
F.C. Ferguson et al.
Varices of the bronchial veins as a source of hemoptysis in mitral stenosis
Am Heart J
(1944)
J.C. Gilroy
The role of the bronchial veins in mitral stenosis
Lancet
(1952)
W.S. Miller
The lung
(1950)
H. Von Hayek
The human lung
(1960)
H. Spencer
C. Nagaishi
C.E. Tobin
The bronchial arteries and their connections with other vessels in the human lung
Surg Gynecol Obstet
(1952)

There are more references available in the full text version of this article.

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: Manuscript received October 2; revision accepted April 12.

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Chest

Clinical InvestigationsEndobronchial Changes in Chronic Pulmonary Venous Hypertension

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

Dis Chest

Am Heart J

Lancet

The lung

The human lung

The bronchial arteries and their connections with other vessels in the human lung

Surg Gynecol Obstet

Clinical Investigations
Endobronchial Changes in Chronic Pulmonary Venous Hypertension