The characteristic pathological pulmonary vascular changes that develop in a patients with Eisenmenger syndrome are confined to arteries only and involve small pulmonary arterioles and muscular arteries (veins are not involved). There is right ventricular hypertrophy (RV walls do not come back to normal size). On x-ray there are dilated and prominent central arteries with rapid tapering (pruning) of the peripheral vasculature.
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