Pulmonary Circulation in Health and Disease ETTORE MAJORANA INTERNATIONAL SCIENCE SERIES Series Editor: Antonino Zichichi European Physical Society Geneva. Switzerland (LiFE SCIENCES) Volume 1 BLADDER TUMORS AND OTHER TOPICS IN UROLOGICAL ONCOLOGY Edited by M. Pavone-Macaluso. P. H. Smith. and F. Edsmyr Volume 2 ADVANCES IN RADIATION PROTECTION AND DOSIMETRY IN MEDICINE Edited by Ralph H. Thomas and Victor Perez-Mendez Volume 3 PULMONARY CIRCULATION IN HEAL TH AND DISEASE Edited by G. Cumming and G. Bonsignore Pulmonary Circulation in Health and Disease Edited by G.Cumming The Midhurst Medical Research Institute Midhurst, Sussex, United Kingdom and G. Bonsignore University of Palermo Palermo, Italy Springer Science+Business Media, LLC Library of Congress Cataloging in Publication Data Main entry under title: Pulmonary circulation in health and disease. (Ettore Majorana international science series: Life sciences; v. 3) "Proceedings of a symposium on the pulmonary circulation held July 16-21,1979, at the Ettore Majorana Center for Scientific Culture, Erice, Sicily, Italy." Includes index. 1. Pulmonary circulation-Congresses. 2. Lungs-Diseases-Congresses. I. Cum ming, Gordon. 11. Bonsignore, G. 111. Series. [DNLM: 1. Pulmonary circulation Congresses. 2. Lung diseases-Physiopathology-Congresses. W1 ET712M v. 3 / WF600 P9823 1979) QP107.P85 612'.2 80-20154 ISBN 978-1-4757-1723-5 ISBN 978-1-4757-1721-1 (eBook) DOI 10.1007/978-1-4757-1721-1 Proceedings of the Symposium on the Pulmonary Circulation, held at the Ettore Majorana Center for Scientific Culture, Erice, Sicily, Italy, July 16-21,1979. © 1980 Springer Science+Business Media New York Originally published by Plenum Press, New York in 1980. Sottcover reprint of the hardcover I st edition 1980 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher FOREWORD This volume documents the proceedings of a symposium on "The Pulmonary Circulation" held at the Ettore Majorana Center for Scientific Culture, in Erice, Sicily, between 16th July and 21st July 1979. This was attended by about 200 participants drawn from Europe as a whole, but the majority were from Southern Europe. The discussion was recorded either in English or Italian and the tapes were reduced to a verbatim typescript by the Ente Nazionale Interpeti Congresso. The verbatim typescript has been edited using a few guiding principles as foliows: 1. Titles and honorifics have been eliminated unless the statement is addressed to a specific person. 2. The style of the speakers in the discussion has been preserved as far as possible and not reduced to a strictly grammatical format. 3. Where references to illustrations (e.g., on the blackboard) are made, the comments have been left unaltered and many are understandable. Removing them detracted from the sense. 4. The air of informality in the proceedings has been preserved so far as possible. 5. The responsibility for the discussion rests solely with the editors, and no contributor has had the opportunity of correcting whae he said. 6. No manuscript was received from one participant, but the discussion of his presentation has been included since it contains some points of substance. G. Cumming and G. Bonsignore v CONTENTS Functional Morphology of the Pulmonary Circulation. ........ . 1 Keith Horsfield Bronchial Circulation: Anatomical Viewpoint ...... . 19 Antonio Blasi Background of Physiology in the Pulmonary Circulat ion . . . .. ..... 27 G. Bonsignore Functional Aspects of the Pulmonary Collateral Circulation . . . . . . . . . . . 43 Alain Lockhart A New Approach for Clinical Study of Control of Respiration . . . . . . . . . . . 69 J. Milic-Emili, M. Aubier, A. Grassino, and J.-Ph. Derenne Active Control of the Pulmonary Circulation ...... . 81 Gwenda R. Barer Congenital Malformations of the Lung: Anatomical Viewpoint 105 Antonio Blasi Recent Developments in the Pharmacokinetic Function of Lung .. . . . . . . . . 113 Y.S. Bakhle The Biochemical Functions of the Pulmonary Circulation . . . . . . . . . . . . . 129 D.M. Geddes vii CONTENTS A Theoretica1 Comparison of Single Breath and Rebreathing Methods of Studying Soluble Gas Exchange in the Lung 139 D.M. Denison, N.J.H. Davies, and D.J. Brown Pu1monary Diffusing Capacity for 02 and CO by Rebreathing Techniques Using Stab1e Isotopes . ..... 1~ M. Meyer, P. Scheid, and J. Piiper The Effects of Regional Hypoxia on the Distribution of Pulrnonary B100d F10w 193 Gordon Curnrning Mechanisms of Pu1monary Arterial Hypertension . . . . . . 199 Henri Deno1in The Nature of Zone 4 in Regional Distribution of Pu1monary B100d F10w . . . . . . . . 211 J. Mi1ic-Emi1i and N.M. Siafakas Man at High A1titude 225 David R. Wi11iams Ultra Structure in Pu1monary Hypertension . . . . . . . . 233 D. Heath Cardio-Respiratory Function in Syndrome of Hypersomnia with Periodic Breathing 249 G. Gune11a Diagnosis of Chronic Cor Pulmonale by Non Invasive Methods .. . . . . . 2~ H. Deno1in Discussion of Paper by Zardini 275 Interaction Between Ventilation and Circu1ation in Bronchial Asthma and Pu1monary Emphysema . 279 P. Even, H. Sors, D. Safran, and P. Reynaud The Ro1e of the Pu1monary Venous System in Regulation of Lung Capi1iary B100d F10w and Tissue Fluid Exchange . . . . . . . . . . . . . . 297 Grant de J. Lee E1ectron Microscopy of Pu1monary Oedema . . . . . . . . . 311 B. Corrin CONTENTS ix Positive Airway Pressure and Lung Edema . . . . . . . . . 327 A. Hauge and G. Nicolaysen Pressure-Flow-Volume Relationships in the Normal Human Pulmonary Circulation at Sea-Level and at Altitude 337 Alain Lockhart Oxygen Transport During Exercise at Altitude . . . . . . 359 Paolo Cerretelli External Imaging of Pulmonary Perfusion and Ventilation . . . . . . . . . 379 Ferruccio Fazio The Role of Prostaglandins in the Respiratory System ....... . .. . 397 R. Paoletti, A. Poli, and E. Tremoli Extra Session 407 Round Table 418 Index 427 FUNCTIONAL MORPHOLOGY OF THE PULMONARY CIRCULATION Keith Horsfield Midhurst Medical Research Institute Midhurst West Sussex GENERAL ARRANGEMENT The main bronchus enters the lung hilum, and by aseries of dichotomous divisions, gives rise to about 25,000 terminal bronchioles, each of which supplies an acinus. At each division the diameters of the bronchi decrease, but at a rate which is less than the increase in numbers, so that the summed cross-sectional area at any given level increases down the tree (Fig 1). Within the acinus dichotomous division continues down to and including the first generation of alveolar ducts, but thereafter branching is more profuse and irregular. Reduction of diameter at each division is, hm-7ever, less (Fig 2) so that there is a very rapid increase in summed cross-sectional area with respect to distance down the acinus. The pulmonary artery branches in similar fashion to the bronchial tree (Fig 3) and follows it closely, although near the hilum the two branching patterns differ slightly. Within the acinus the pulmonary artery is applied to the respiratory bronchioles along their non-alveolated sides, and finally gives rise to branches which course over the alveoli arising from alveolar ducts. As in the bronchial tree, branches decrease in diameter at each dichotomy, and this decrease continues all the way along the acinus to the alveolar capillaries (Fig 4) while the summed cross-sectional area increases. Although the two trees are similar, the arte ries branch more profusely, especially peripherally, where they give off branches to supply alveoli on respiratory bronchioles and immediately adjacent alveoli of neighbouring ac±ni (Fig 5). The pulmonary veins arise from capillaries at duct junctions, on respiratory bronchioles, on the pleura, and in septae, those starting