Bronchoscopic Lung-Volume Reduction With One-Way Valves in Patients With Heterogenous Emphysema

Venuta, Federico; Giacomo, Tiziano De; Rendina, Erino Angelo; Ciccone, Anna Maria; Diso, Daniele; Perrone, Anna; Parola, D; Anile, Marco; Coloni, Giorgio F.

doi:10.1016/j.athoracsur.2004.07.048

Cited by 106 publications

(101 citation statements)

References 18 publications

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“…Lung volume reduction surgery and bulla resection may be a palliative option when medical therapy has failed; however only a limited number of patients are suited. In these cases the endobronchial approach could provide palliation with less risk than surgical treatment, removing the least hyperinflated lung in order to relieve dyspnea and improve quality of life [8][9][10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

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Successful treatment of persistent postoperative air leaks following the placement of an endobronchial one-way valve

Conforti

Torre

Fieschi

et al. 2016

Monaldi Arch Chest Dis

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resection in pathological conditions of the lung involve a very large spectrum of available methods, from chest drainage and placement of Heimlich valves to surgical repair or pleural decortication. However, in some of these patients surgery may be contraindicated. This report describes an endobronchial approach to the control of marked and prolonged air leaks in four patients using a newly designed one-way airway valve (Pulmonx Corporation; Redwood City, Ca.USA) placed into the segmental bronchus that is the source of air leakage. As the device is a one-way inspiratory airway blocker, it can be used to control persistent air leaks while maintaining the drainage of mucus. This approach potentially provides an effective nonsurgical and minimally invasive alternative addition to the armamentarium of treatments for patients who suffer with persistent post-operative air leaks where other methods have failed or in frail patients who are categorised as a high surgical risk.

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Section: Discussionmentioning

confidence: 99%

“…USA) is designed primarily for endoscopic lung volume reduction in lung emphysema. The initial safety and efficacy of valves in this disease is encouraging and the results from multicentre, prospective, randomised controlled trials are awaited [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Successful treatment of persistent postoperative air leaks following the placement of an endobronchial one-way valve

Conforti

Torre

Fieschi

et al. 2016

Monaldi Arch Chest Dis

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“…BLVR has been tried with either the placement of a valve (or similar device) in the segmental bronchi to produce distal atelactasis, or by inducing collapse or fibrosis via selective chemical treatment of the affected lung areas. The placement of a valve prosthesis can be performed bronchoscopically in human lungs [13], but although this has been proven safe and effective, some complications have been noted [14,15]. Recently, an umbrella-shaped device (Spiration, Redmond, WA, USA), consisting of a polyurethane membrane on a nitinol frame, has been tried and shows promise [16].…”

Section: Discussionmentioning

confidence: 99%

Transbronchial decompression of emphysematous bullae: a new therapeutic approach

Bhattacharyya¹,

Sarkar²,

S³

et al. 2007

European Respiratory Journal

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Bullae are common accompaniments of chronic obstructive pulmonary disease especially emphysema. They contribute to increased lung volume and worsen the mechanical disadvantage of the inspiratory muscles by increasing the residual volume (RV) and RV/total lung capacity ratio. Thus effective decompression of a large bulla or bullae is thus important to improve the lung function of affected patients and also to provide symptomatic relief. Surgery and thoracoscopy are two commonly performed procedures used to treat bullae. Although bronchoscopic lung volume reduction has been successfully accomplished for emphysema, isolated decompression of bullae bronchoscopically has not been tried to date.A large emphysematous bulla in the left lower lobe of a surgically unfit patient was bronchoscopically punctured with a transbronchial aspiration needle; the position of the needle inside the bulla was confirmed and the air from the bulla was aspirated slowly to allow collapse. Finally, some autologous blood was instilled into the bulla before the needle was withdrawn.The patient had immediate and sustained symptomatic relief with significant improvement in lung function.Bronchoscopic transbronchial decompression of emphysematous bullae can be an effective therapeutic option and warrants further investigation. KEYWORDS: Bronchoscopic lung volume reduction, emphysematous bulla, fibreoptic bronchoscopy, lung volume reduction surgery A 50-yr-old male nonsmoker, presented with incapacitating shortness of breath, cough, fever and increased expectoration of mucoid sputum for 2 weeks. The patients had been suffering from progressive shortness of breath with episodic exacerbations associated with cough, expectoration and occasional history of wheeze over the previous 15 yrs. The patient had stopped smoking 7 yrs earlier, prior to which he had smoked heavily for .20 yrs.On examination the patient was poorly nourished (body mass index 16.75 kg?m -2 ) and grossly dyspnoic (orthopnoic on supplemental oxygen and incapable of getting out of bed), with a cardiac frequency of 130 bpm and blood pressure of 120/80 mmHg. The chest was emphysematous, however, there was no clubbing, raised jugular venous pressure or pedal oedema, but the accessory muscles of inspiration were working vigorously. The chest bellow was bilaterally symmetrical with reduced expansion (¡1 cm) and obliteration of the liver dullness. Breath sounds were grossly diminished on both sides, especially so on the left base. All other systems were essentially normal on examination.The laboratory investigations revealed haemoglobin of 11.20%, total leukocyte count was 9,800 per mm 3 with neutrophils and lymphocytes consisting 77 and 20%, respectively, and an erythrocyte sedimentation rate of 62 mm. Except initial hypokalaemia (3.2 mEq?L -1 ), serum electrolytes, blood urea nitrogen, creatinine and liver-function test results were all normal. The sputum did not reveal any acid-fast bacilli on three occasions but sputum culture showed growth of Klebsiella species sensitive t...

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“…Early studies were based on observational studies and indicated that EBV implantation was safe, but most studies have found that EBV implantation has little benefit (11)(12)(13)(14)(15)(16)(17). A series of early studies indicated that EBV implantation substantially benefited patients in whom the target lobe collapsed and in whom target lung volume reduction (TLVR) was achieved, but TLVR was achieved in only 24.9% of patients (11)(12)(13)(14)(15). Post-procedure quality of life and exercise capacity improved to some extent for patients with no significant collapse of the target lobe, the difference was not statistically significant (16,17).…”

Section: Endobronchial Valves and Intrabronchial Valvesmentioning

confidence: 99%

“…In some studies, ventilation/perfusion scintigraphy of the lungs is routinely performed (11)(12)(13)(14)(15)(16)(17)(18). The state of lung perfusion is usually consistent with the extent of damage (47), but in a few instances the state of lung perfusion and extent of emphysema may differ because local vascular inflammation has induced vascular remodeling, which can also lead to irregularities in pulmonary perfusion (48,49).…”

Section: Other Predictorsmentioning

confidence: 99%

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

Wang

et al. 2016

BST

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Bronchoscopic Lung-Volume Reduction With One-Way Valves in Patients With Heterogenous Emphysema

Cited by 106 publications

References 18 publications

Successful treatment of persistent postoperative air leaks following the placement of an endobronchial one-way valve

Successful treatment of persistent postoperative air leaks following the placement of an endobronchial one-way valve

Transbronchial decompression of emphysematous bullae: a new therapeutic approach

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

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