The pulmonary circulation is a division of the circulatory system in all vertebrates. The circuit begins with deoxygenated blood returned from the body to the right atrium of the heart where it is pumped out from the right ventricle to the lungs. In the lungs the blood is oxygenated and returned to the left atrium to complete the circuit. The other division of the circulatory system is the systemic circulation that begins upon the oxygenated blood reaching the left atrium from the pulmonary circulation. From the atrium the oxygenated blood enters the left ventricle where it is pumped out to the rest of the body, then returning as deoxygenated blood back to the pulmonary circulation. A separate circulatory circuit known as the bronchial circulation supplies oxygenated blood to the tissues of the lung that do not directly participate in gas exchange.
Anatomy
The pulmonary arteries have both an internal and external elastic membrane, whereas pulmonary veins have a single (outer) elastic layer.
Arteries
From the right ventricle, blood is pumped through the semilunar pulmonary valve into the left and right main pulmonary artery (one for each lung), which branch into smaller pulmonary arteries that spread throughout the lungs.
Veins
Oxygenated blood leaves the lungs through pulmonary veins, which return it to the left part of the heart, completing the pulmonary cycle.
Physiology
Two pulmonary circulations The lung actually possesses a high-flow, low-pressure circulation which passes deoxygenated blood from the right heart through the capillaries surrounding the alveoli to be oxygenated, and a low-flow, high-pressure (just slightly lower than systemic arterial pressure) circulation which supplies oxygenated blood to other structures of the lung (airways, supporting tissues, and the vasa vasorum) via the bronchial arteries. This oxygenated blood supplied by the bronchial arteries amounts to 1–2% of left heart output, and is drained into the pulmonary venous system and returned to the left atrium. Pulmonary arterial pressure normally measures about 25 mmHg during systole, about 8 mmHg during diastole, for a mean arterial pressure of 15 mmHg.
Capacity and compliance Compared to the systemic circulation, the pulmonary circulation has less than 1/8th the capacitance and contains ~1/10th the blood volume. The pulmonary arteries and veins are short vessels. To accommodate the right ventricular stroke volume, the pulmonary arterial system has very high compliance; this is achieved by all pulmonary arteries possessing much larger diameters compared to systemic counterparts, as well as thin and distensible walls. Pulmonary blood flow is essentially equal to cardiac output. Pulmonary vessels typically function as distensible conduits that distend at higher intraluminal pressures and narrow with lower pressures.
Blood flow, blood pressure and vascular resistance The (alveolar) pulmonary circulation operates as a very low pressure and resistance system. Indeed, blood pressure in the circulation is normally just sufficient to maintain blood flow in all parts of the lungs. Nevertheless, the pulmonary circulation can accommodate significantly increased flow during periods of increased demand. Abnormally high blood pressures in the pulmonary circulation (e.g. in left-sided heart failure) cause excess fluid to transude from the blood vessels into the alveoli and accumulate here, causing pulmonary edema and impairing gas exchange. Pulmonary capillary pressure is estimated to normally stand at about 7mmHg (compared to about 17 mmHg in capillaries of the systemic circulation), though it has not been measured directly. During very heavy demand (e.g. during strenuous exercise), pulmonary blood flow may be increased to 4-fold to 7-fold of normal. The additional blood flow is accommodated by increasing the number of open capillaries (up to 3-fold greater), distending capillaries (up to 2-fold greater flow), and increasing pulmonary blood pressure; the former two mechanisms accommodate the additional blood flow by reducing vascular resistance and can normally accommodate all the additional required blood flow even at peak demand with little additional increase of pulmonary blood pressure. Blood normally passes through a pulmonary capillary in about 0.8 s, but the time spent traversing the capillaries is as little as 0.3 s during maximal blood flow.
Autoregulation of alveolar blood flow Lung tissue is capable of reducing perfusion of poorly ventilated alveoli to redirect blood flow to better ventilated ones. Reduced O2 concentration in an alveolus causes adjacent blood vessels to constrict; vascular resistance may increase more than 5-fold with very low alveolar O2 levels. Hypoxic vasoconstriction of alveolar blood vessels is thought to be mediated by increased action of vasoconstrictors (e.g. endothelin, and reactive oxygen species), decreased release of vasodilators (e.g. nitric oxide), and closing of oxygen-sensitive K+ channels in vascular smooth muscle (directly causing depolarisation and consequent constriction of muscle).
Hydrostatic effects and pulmonary blood flow The hydrostatic pressure of blood within blood vessels exhibits a gradient across the lung (as do blood vessels across any axis of the body). In an upright person, the lung normally measures 30 cm top-to-bottom for a hydrostatic pressure gradient of 23 mmHg, of which 15 mmHg is superior to the level of the heart. Consequently, in a standing person at rest, there is 5 times more blood flow at the bottom of the lung than at the top. The hydrostatic pressure gradient can lead to three different blood flow scenarios in different parts of the lung:
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