UNILATERAL MEMBRANOUS PULMONARY VENOUS OCCLUSION, PULMONARY HYPERTENSION, AND PATENT DUCTUS ARTERIOSUS

Abstract

A few patients with patent ductus arteriosus develop cyanosis from intermittent or established shunt-reversal caused by pulmonary hypertension. In these patients the Gibson murmur is absent and clinical and electrocardiographic evidence of right ventricular hypertrophy is found (Cosh, 1953; Hultgren et al., 1953). The pulmonary hypertension can be the result of raised pulmonary vascular resistance, due to persistence of the foetal pattern of pulmonary arteries and arterioles, to reflex pulmonary vaso-constriction, or to the development of degenerative changes in the pulmonary arterial tree. Increased resistance to blood flow beyond the pulmonary capillaries has not so far been suggested as a possible cause of pulmonary hypertension in patients with patent ductus. The case reported here had a membranous occlusion of the right pulmonary veins, as well as pulmonary arterial hypertension, a patent ductus arteriosus, and central cyanosis. The unilateral pulmonary venous occlusion was responsible for a bizarre and puzzling X-ray picture of the chest. The relationship between the pulmonary venous occlusion, the pulmonary arterial hypertension, and the failure of the ductus arteriosus to close is worthy of consideration.