Pulmonary arterial hypertension (PAH) has become an important topic of basic and clinical research in recent years. Morphologic researches have shown that specific PAH-lesions are located in the lobular small muscular arteries and correlate with hemodynamic measurements. However, it still remains to be shown how pathological changes of the small arteries in the lobule develop to PAH. Based on both fractal properties of pulmonary arterial tree and asynchronous phasic contractions of lobular arterial muscles under the evenness of the pulmonary capillary pressure (PCP) in the lung, the author has constructed an integrated model of pulmonary circulation which has produced a mathematical relationship between the mean pulmonary arterial pressure (MPAP) and the cardiac output (CO). By use of the expression between MPAP and CO, it has been able to explain the pathogenesis of PAH in terms of statistical changes among regional and temporal perfusions in the lung. In order to detect clinically the early stage of PAH, the author has suggested that it is important to establish the pulmonary functional imaging of regional and temporal perfusions.
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