[Tuberculosis sequelae: pathophysiological aspects (pulmonary circulation)]

Abstract

223 cases with pulmonary tuberculosis sequelae underwent the examinations of arterial blood gases, pulmonary function or right cardiac catheterization. Especially 86 cases were investigated of pulmonary hemodynamics. We discussed about the findings on chest X-ray film--emphysematous change; fibrosis, bronchiectasis, cavity; atelectasis, pneumonectomy; pleural peel; thoracoplasty--in tuberculosis sequelae to influence pulmonary hypertension, about pulmonary hemodynamics, in the past history, with or without right heart failure, about the difference between tuberculosis sequelae and chronic obstructive pulmonary disease (COPD) in pulmonary hemodynamics, and about prognosis in patients with tuberculosis sequelae. The summary of results was as follows: 1. The most influential chest X-ray finding on pulmonary hypertension is pleural peel. 2. In cases without right heart failure in the past, the values of arterial blood gases, pulmonary function and pulmonary hemodynamics were better. The effect of reduction of pulmonary arteriolar resistance was good in cases without right heart failure under the condition of oxygen inhalation. 3. Pulmonary artery mean pressure in tuberculosis sequelae tended to be higher than in COPD under the even conditions of PaO2 and FEV1/prVC%. Nocturnal desaturation was more in tuberculosis sequelae. 4. Prognosis of tuberculosis sequelae was poor in patients with pulmonary hypertension though there was no statistical significance at present. In conclusion, for the early diagnosis and management of pulmonary circulatory disorder in tuberculosis sequelae, we thought it was important to follow the clinical course with special attention to chest X-ray findings, to start oxygen therapy before right heart failure takes place, and to make an effort to extend the indication of home oxygen therapy.