[Chronic cor pulmonale and chronic pulmonary tuberculosis].
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The morbid anatomical factors in the production of right heart hypertrophy and failure in emphysema have been reviewed with reference to 44 cases studied by standard histological methods and by post-mortem pulmonary arteriography. The most important factors in raising the pulmonary vascular resistance in these cases are considered to be vascular deformity and pressure by the emphysematous spaces on the adjacent branches of the pulmonary artery. Precapillary bronchopulmonary arterial anastomoses may be of importance in those cases where areas of localized bronchiectasis are present. Intimal fibrosis of the pulmonary arterioles, destruction of the pulmonary vascular bed, and thromboembolic phenomena were thought to be of only minor importance in the production of cor pulmonale in emphysema.
Examination of the post-mortem records of 1,391 unselected cases showed that the commonest condition associated with excessive diffuse enlargement of the kidneys was chronic cor pulmonale. A less striking enlargement was found in some cases of chronic rheumatic heart disease.A hypothesis is put forward in which the renal enlargement is regarded as a work hypertrophy brought about by the kidneys' efforts to compensate for a chronic respiratory acidosis.
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