The structure and function of the pulmonary circulation was investigated in 17 patients requiring pulmonary resection. All 17 performed pulmonary function tests and 13 underwent right heart catheterization preoperatively. The surgical specimens of the lung were analyzed with respect to the severity of the emphysema, the severity of the airways disease, and the hypertensive changes in the small pulmonary arteries and arterioles. The data show that pulmonary artery (Ppa) and pulmonary artery wedge (Ppaw) pressures and cardiac output were normal at rest. However, patients with more severe disease showed greater increases in Ppa and Ppaw with exercise than did patients with minimal or no disease. Oxygen breathing had no effect at rest but lowered Ppa and Ppaw during exercise in the patients with more severe disease. Histologic studies showed that greater degrees of emphysema and small airways disease were associated with hypertensive changes in the pulmonary vasculature. We conclude that patients with moderat...