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The in utero environment of the pulmonary circulation is unique. During fetal life, the lung is fluid filled, oxygen tension low, pulmonary blood flow limited, and pulmonary vascular resistance exceeds systemic vascular resistance. Blood is shunted away from the lungs at the level of the ductus arteriosus. At birth, pulmonary blood flow increases eightfold to tenfold and pulmonary artery pressure...