Hemodynamic Effects of Bronchopulmonary Anastomosis in Unilateral Chronic Inflammatory Diseases of the Lung

¹ From the Department of Thoracic Surgery, Kansai Medical School, Osaka, Japan

In six patients with unilateral chronic inflammatory diseases of the lung, the hemodynamic effects of bronchopulmonary anastomosis were evaluated by such means as selective pulmonary and bronchial angiography and right cardiac catheterization; moreover, the pathohistologic findings in the resected lungs were compared. In all six, pulmonary angiograms indicated little or no flow; in contrast, bronchial arteriograms showed increased flow in the involved lungs. The patterns of bronchopulmonary blood flow might be classified into two types. In type A, bronchial blood flowed into the pulmonary vein through an abundant capillary network; in type B, bronchial blood flowed into an adjacent pulmonary artery through the precapillary collateral anastomosis and regurgitated into the contralateral pulmonary artery. The factors determining these patterns may be the stage and nature of the pulmonary inflammation. In three patients with the type-B pattern, 1.4 to 2.0 L/min of left-to-right shunt with mild pulmonary hypertension was demonstrated. Although the shunt volume is not large, the volume load on the contralateral lung has to double because of the decreased total pulmonary vascular bed. The results after pneumonectomy were excellent in all six, and the pulmonary hypertension was well reduced in two such patients.