The Pathogenesis and Treatment of Right Heart Failure with Special References to Cor Pulmonle

Abstract

(1) Out of 300 autopsy cases in Yokufuen (old people's home) during the last 3 years, 26 cases were diagnosed as cor pulmonale : 20 cases as pulmonary emphysema and 6 cases as pulmonary tuberculosis. Although the emphysema is much more common in men, no marked sex difference was noted in the rate of development of cor pulmonale from pulmonary emphysema. (2) Histological examination showed a marked thickening of the intima and media throughout the arterioles, muscular arteries and elastic arteries of the pulmonary vessels. Intima fibrosis and the increase of elastica were also found. These changes are seconday manifestations of the disturbances in pulmonary circulation. (3) From the studies with post-mortem pulmonary arteriography, the morphological factor in the cause of pulmonary hypertension is considered to be loss of pulmonary vascular bed. (4) Effects of hypoxia, hypercapnia, intrapulmonary air pressure and drugs on the pulmonary vascular resistance were tested in the thoracotomized dogs. The results challenge the concept that the tone of pulmonary vessel plays an important role in the cause of pulmonary hypertension. The data suggest that the regulation of pulmonary circulation may be determined by intrapulmonary air pressure. (5) There are many cases of cor pulmonale in which a physiological abnormality rather than the morphological changes of pulmonary vascular bed is the determinant of the pulmonary hypertension. Disability of the heart in these cases can be relieved by the treatment. Therapeutic efforts are directed not only at the treatment of the heart failure but also toward the elimination the results of pulmonary dysfunction.