The third biennial meeting of the da Vinci Society for the Study of the Circulation was held at the University of Bordeaux, France, from September 12‐14, 1995. There were 44 participants from nine different countries. The topic of the meeting was Airway Circulation in Health and Disease: Interaction between Vasculature and Pulmonary Smooth Muscles. Thirty one presentations were given and these were followed by lively discussions. Guest speaker, Paul Vanhoutte, gave a stimulating talk entitled Epithelium, Endothelium and Smooth Muscles in Walls. Old topics that had been at the forefront some decades ago were revisited and new insights into the physiology and pathophysiology of the airway circulation were discussed. Haemodynamics of the airway circulation The site of anastomoses between the bronchial and the pulmonary circulation is still the subject of debate. Striking angiogenesis of the airway circulation and medial hypertrophy of small pulmonary arteries have been observed 4 months after ligation of the left pulmonary artery in dogs. Using the sudden occlusion technique to measure pre- and postcapillary pulmonary vascular resistance in the in situ perfused left lower lobe of dogs, R. Michel was able to localize anastomoses between the bronchial and the pulmonary circulations at the precapillary level. There may be similarities between these findings and those from a study performed by D. Schraufnagel in rats. The rats, made cirrhotic by ligation of the bile duct, developed a striking increase of the vasa vasorum of the pulmonary arteries, as demonstrated by use of plastic casting. P. Pare has also investigated the extent of these anastomoses in open-chested, anaesthetized sheep. Radiolabelled red blood cells were injected into the common bronchial artery of sheep, whilst blood samples were obtained simultaneously from the aorta, the left ventricle, inferior vena cava and the right ventricle; this is a revival of the classical single-injection, multiple-sampling indicator-dilution method. The timing and the area under the indicator dilution curves were calculated. The results showed that at least 80% of the venous return from the bronchial circulation drained to the left side of the heart, whereas less than 20% returned to the right heart. In additional studies, Pare also examined the extraction of labelled polymorphonuclear leucocytes (PMNs) injected directly into the pulmonary or the bronchial artery. First-pass extraction of the PMNs was much lower in the bronchial compared to the pulmonary circulation (50 vs 80‐90%), suggesting that some of the anastomoses between the bronchial and the pulmonary vasculature were at the postcapillary level. In summary, results from the dogs and rats demonstrated considerable remodelling of the bronchial circulation and evidence for precapillary anastomoses; whereas, in the acute study in normal sheep, at least some of the anastomoses were postcapillary. At this stage, it does not seem possible to decide whether this is due to species differences or to the effects of angiogenetic remodelling of the bronchial circulation in some studies.
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