Ralph C. Jung

Pulmonary artery to vein shunts in obstructive pulmonary disease

Abstract Forty-six patients with chronic respiratory disease were studied; all but two had obstructive pulmonary disease. In none were intracardiac shunts or pulmonary arteriovenous fistulas detected. In four patients with obstructive pulmonary disease a direct pulmonary artery to vein connection was identified by peripheral pulmonary wedge arteriography. The findings in these four patients (history, physical examination, electrocardiography, chest roentgenography, cardiac catheterization, pulmonary function studies and angiography), compared with those in the remaining patients in whom no shunt was visualized, revealed no discriminating differences. All patients with pulmonary artery to vein connections had moderately severe obstructive pulmonary disease and moderate degrees of pulmonary hypertension. Pulmonary vascular resistance was significantly increased. When measured, the arterial blood pO 2 at the end of a twenty minute period of oxygen breathing was significantly decreased. However, many patients without definitely identifiable shunts showed similar degrees of abnormality. Since many of the latter had arterial blood pO 2 of from 134 to 350 mm. Hg during 100 per cent oxygen breathing, it is likely that arteriovenous shunts were present but not identified by the method of pulmonary arteriography employed.