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J Clin Invest. 1979 Oct; 64(4): 1050–1055.
PMCID: PMC372215

Mechanisms of gas exchange abnormality in patients with chronic obliterative pulmonary vascular disease.


We have examined the mechanisms of abnormal gas exchange in seven patients with chronic obliteration of the pulmonary vascular bed secondary to recurrent pulmonary emboli or idiopathic pulmonary hypertension. All of the patients had a widened alveolar-arterial oxygen gradient and four were significantly hypoxemic with arterial partial presssures of oxygen less than 80 torr. Using the technique of multiple inert gas elimination, we found that ventilation-perfusion (VA/Q) relationships were only minimally abnormal with a mean of 10% (range, 2--19%) of cardiac output perfusing abnormal units. These units consisted of shunt and units with VA/Q ratios less than 0.1. In addition, the dead space was found to be normal in each patient. There was no evidence for diffusion impairment, and the widened alveolar-arterial oxygen gradient was completely explained by VA/ inequality. Significant hypoxemia occurred only when VA/Q inequality was combined with a low mixed venous oxygen content.

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Selected References

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  • Gazetopoulos N, Salonikides N, Davies H. Cardiopulmonary function in patients with pulmonary hypertension. Br Heart J. 1974 Jan;36(1):19–28. [PMC free article] [PubMed]
  • Walcott G, Burchell HB, Brown AL., Jr Primary pulmonary hypertension. Am J Med. 1970 Jul;49(1):70–79. [PubMed]
  • Daoud FS, Reeves JT, Kelly DB. Isoproterenol as a potential pulmonary vasodilator in primary pulmonary hypertension. Am J Cardiol. 1978 Nov;42(5):817–822. [PubMed]
  • Shettigar UR, Hultgren HN, Specter M, Martin R, Davies DH. Primary pulmonary hypertension favorable effect of isoproterenol. N Engl J Med. 1976 Dec 16;295(25):1414–1415. [PubMed]
  • Wang SW, Pohl JE, Rowlands DJ, Wade EG. Diazoxide in treatment of primary pulmonary hypertension. Br Heart J. 1978 May;40(5):572–574. [PMC free article] [PubMed]
  • DODGE HT, LORD JD, SANDLER H. Cardiovascular effects of isoproterenol in normal subjects and subjects with congestive heart failure. Am Heart J. 1960 Jul;60:94–105. [PubMed]
  • Mookherjee S, Keighley JF, Warner RA, Bowser MA, Obeid AI. Hemodynamic, ventilatory and blood gas changes during infusion of sodium nitroferricyanide (nitroprusside). Studies in patients with congestive heart failure. Chest. 1977 Sep;72(3):273–278. [PubMed]
  • Wagner PD, Dantzker DR, Iacovoni VE, Tomlin WC, West JB. Ventilation-perfusion inequality in asymptomatic asthma. Am Rev Respir Dis. 1978 Sep;118(3):511–524. [PubMed]
  • Wagner PD, Naumann PF, Laravuso RB. Simultaneous measurement of eight foreign gases in blood by gas chromatography. J Appl Physiol. 1974 May;36(5):600–605. [PubMed]
  • Lynch JP, Mhyre JG, Dantzker DR. Influence of cardiac output on intrapulmonary shunt. J Appl Physiol Respir Environ Exerc Physiol. 1979 Feb;46(2):315–321. [PubMed]
  • Wagner PD, Saltzman HA, West JB. Measurement of continuous distributions of ventilation-perfusion ratios: theory. J Appl Physiol. 1974 May;36(5):588–599. [PubMed]
  • Evans JW, Wagner PD. Limits on VA/Q distributions from analysis of experimental inert gas elimination. J Appl Physiol Respir Environ Exerc Physiol. 1977 Jun;42(6):889–898. [PubMed]
  • BLAKEMORE WS, FORSTER RE, MORTON JW, OGILVIE CM. A standardized breath holding technique for the clinical measurement of the diffusing capacity of the lung for carbon monoxide. J Clin Invest. 1957 Jan;36(1 Pt 1):1–17. [PMC free article] [PubMed]
  • GOLDMAN HI, BECKLAKE MR. Respiratory function tests; normal values at median altitudes and the prediction of normal results. Am Rev Tuberc. 1959 Apr;79(4):457–467. [PubMed]
  • McGRATH MW, THOMSON ML. The effect of age, body size and lung volume change on alveolar-capillary permeability and diffusing capacity in man. J Physiol. 1959 Jun 11;146(3):572–582. [PMC free article] [PubMed]
  • Wagner PD, Laravuso RB, Uhl RR, West JB. Continuous distributions of ventilation-perfusion ratios in normal subjects breathing air and 100 per cent O2. J Clin Invest. 1974 Jul;54(1):54–68. [PMC free article] [PubMed]
  • WILLIAMS MH., Jr Mechanical vs. reflex effects of diffuse pulmonary embolism in anesthetized dogs. Circ Res. 1956 May;4(3):325–331. [PubMed]
  • Levy SE, Simmons DH. Mechanism of arterial hypoxemia following pulmonary thromboembolism in dogs. J Appl Physiol. 1975 Jul;39(1):41–46. [PubMed]
  • Dantzker DR, Wagner PD, Tornabene VW, Alazraki NP, West JB. Gas exchange after pulmonary thromboemoblization in dogs. Circ Res. 1978 Jan;42(1):92–103. [PubMed]
  • Wilson JE, 3rd, Pierce AK, Johnson RL, Jr, Winga ER, Harrell WR, Curry GC, Mullins CB. Hypoxemia in pulmonary embolism, a clinical study. J Clin Invest. 1971 Mar;50(3):481–491. [PMC free article] [PubMed]
  • BURCHELL HB, EDWARDS JE, SHEPHERD JT, SWAN HJ, WOOD EH. Clinical, physiological, and pathological considerations in patients with idiopathic pulmonary hypertension. Br Heart J. 1957 Jan;19(1):70–82. [PMC free article] [PubMed]
  • West JB. State of the art: ventilation-perfusion relationships. Am Rev Respir Dis. 1977 Nov;116(5):919–943. [PubMed]
  • Stanger P, Lucas RV, Jr, Edwards JE. Anatomic factors causing respiratory distress in acyanotic congenital cardiac disease. Special reference to bronchial obstruction. Pediatrics. 1969 May;43(5):760–769. [PubMed]
  • Albert RK, Lakshminarayan S, Huang TW, Butler J. Fluid leaks from extra-alveolar vessels in living dog lungs. J Appl Physiol Respir Environ Exerc Physiol. 1978 May;44(5):759–762. [PubMed]
  • Whayne TF, Jr, Severinghaus JW. Experimental hypoxic pulmonary edema in the rat. J Appl Physiol. 1968 Dec;25(6):729–732. [PubMed]
  • Caldini P, Leith JD, Brennan MJ. Effect of continuous postive-pressure ventilation (CPPV) on edema formation in dog lung. J Appl Physiol. 1975 Oct;39(4):672–679. [PubMed]
  • SEVERINGHAUS JW, STUPFEL M. Alveolar dead space as an index of distribution of blood flow in pulmonary capillaries. J Appl Physiol. 1957 May;10(3):335–348. [PubMed]
  • Hlastala MP, Robertson HT, Ross BK. Gas exchange abnormalities produced by venous gas emboli. Respir Physiol. 1979 Jan;36(1):1–17. [PubMed]
  • SWENSON EW, FINLEY TN, GUZMAN SV. Unilateral hypoventilation in man during temporary occlusion of one pulmonary artery. J Clin Invest. 1961 May;40:828–835. [PMC free article] [PubMed]
  • Levy SE, Simmons DH. Redistribution of alveolar ventilation following pulmonary thromboembolism in the dog. J Appl Physiol. 1974 Jan;36(1):60–68. [PubMed]
  • Kafer ER. Respiratory function in pulmonary thromboembolic disease. Am J Med. 1969 Dec;47(6):904–915. [PubMed]

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