IV. The Pathology of the Pulmonary Vessels in Pulmonary Hypertension

Abstract

The present communication is concerned with the post-mortem findings in the groups of cases of pulmonary hypertension that have been discussed by the previous speakers. The pulmonary vasculature in such cases has been investigated by post-mortem angiography, dissection and histology (Doyle, Goodwin, Harrison, and Steiner, 1957). The changes in mitral stenosis will be described first, then the changes in hyperdynamic congenital heart disease and finally the findings in the other groups. In brief the findings in post-mortem angiographs confirm those of in vivo angiographs. The pulmonary arteries in the upper part of the lungs were either dilated or normal whilst those in the lower parts were relatively narrowed (Figs. 1 and 2). The detailed findings were as follows. Out of 38 cases the main pulmonary arteries were dilated in 16 and normal in 22. These figures are based on comparisons with normal controls. In the segmental pulmonary arteries and their first branches, there was a difference between upper and lower zones: in the upper zones 13 cases showed dilatation, 24 were of normal size and one case was narrowed. In the lower zones only two cases showed dilatation, 17 were of normal size, 17 were narrowed and two could not be assessed owing to embolism. Of the 36 cases that could be assessed 25 showed a perceptible difference between the two zones. In the smaller arteries these differences were more striking.