Effects of acetylcholine on regional pulmonary blood flow in patients with mitral stenosis.

The effect of acetylcholine was studied on the region of increased vascular resistance at the lung bases in patients with mitral stenosis. The patients had moderate elevations of pulmonary artery pressure. The distribution of blood flow and ventilation were measured in both lungs of 10 patients using radioactive xenon-133 and a scanning technique. Acetylcholine was then infused into one main pulmonary artery, and the distribution of blood flow and ventilation were measured again. One lung served as a control during the drug infusion. There was a small but significant increase in perfusion to the dependent lung zone during the drug infusion without a change in pulmonary artery pressure indicating localized vasodilation. Relative underperfusion was still present during the acetylcholine administration which indicated that increased vasomotor tone was not the principal pathophysiological mechanism for the increased vascular resistance. There was a decrease in ventilation to the lower zone of the lung receiving acetylcholine.