Endobronchial Valves in the Management of Broncho-Pleural and Alveolo-Pleural Fistulae

Abstract

Pneumothorax from bronchopleural or alveolo-pleural fistulae can be complicated by prolonged air leak (AL). This can occur in a variety of clinical settings. Examples include structural lung disease, such as bronchiectasis, and cavitary lung disorders. Prolonged AL is associated with prolonged hospital stay, atelectasis, pneumonia, and thromboembolic disease. Endobronchial valves (EBVs) have been recently introduced to manage such situations. The global experience in this novel therapeutic modality is still evolving. We report our preliminary experience with managing persistent AL treated successfully with EBVs and review the current literature on this subject. Our experience shows that EBVs are an effective tool for the management of prolonged AL from persistent bronchopleural or alveolo-pleural fistulae. It is a minimally invasive procedure recommended as an option, particularly in patients not fit for surgical repair.

Endobronchial Valves for Challenging Air Leaks

“…Their efficacy for management of postoperative air leak was later defined [1,9,11,12]. Other case reports have defined additional clinical scenarios in which EBVs were effectively used for elimination of airflow to specific regions of the lung [11,14,[16][17][18][19][20].…”

Intrabronchial Valves for Treatment of Alveolar-Pleural Fistula in a Patient With Pneumocystis jirovecii Pneumonia

“…15,16 However, valves are also increasingly utilized in patients with persistent air leaks. 17,18 In our institution, placement of intrabronchial valves for persistent air leaks is approved under the institutional review board protocol (HSM#11-00015). Informed consent was obtained from our patient before the procedure.…”

Rare Cavitary MAC Lung Disease Causing a Serious Broncho-Pleural Air Leak in an Immune Competent Patient

“…It is usually treated with a drug combination for a period of 12 months [4,5]. In case of MAC lung disease with broncho-pleural or alveolar-pleural fistulas, endobronchial valves insertion can be attempted by experienced pulmonologists [6]. In advanced non-tuberculous mycobacterial pleuro-pulmonary disease, surgical interventions such as segmentectomy, lobectomy, pneumonectomy, or pleural decortication might be required with varying degree of morbidity and mortality [7,8].…”