TY - JOUR
T1 - Bronchial fenestration improves expiratory flow in emphysematous human lungs
AU - Lausberg, Henning F.
AU - Chino, Kimiaki
AU - Patterson, G. Alexander
AU - Meyers, Bryan F.
AU - Toeniskoetter, Patricia D.
AU - Cooper, Joel D.
AU - Wood, Douglas E.
AU - Weder, Walter
AU - Miller, Daniel
AU - Demeester, Steven R.
AU - Locicero, Joseph
N1 - Funding Information:
The authors acknowledge the expert technical assistance provided by Kathryn Fore, Laura Martini, and Dennis Gordon. This work was supported in part by National Institutes of Health grant R01 (HL62194).
PY - 2003/2/1
Y1 - 2003/2/1
N2 - Background. The crippling effects of emphysema are due in part to dynamic hyperinflation, resulting in altered respiratory mechanics, an increased work of breathing, and a pervasive sense of dyspnea. Because of the extensive collateral ventilation present in emphysematous lungs, we hypothesize that placement of stents between pulmonary parenchyma and large airways could effectively improve expiratory flow, thus reducing dynamic hyperinflation. Methods. Twelve human emphysematous lungs, removed at the time of lung transplantation, were placed in an airtight ventilation chamber with the bronchus attached to a tube traversing the chamber wall, and attached to a pneumotachometer. The chamber was evacuated to -10 cm H2O pressure for lung inflation. A forced expiratory maneuver was simulated by rapidly pressurizing the chamber to 20 cm H2O, while the expiratory volume was continuously recorded. A flexible bronchoscope was then inserted into the airway and a radiofrequency catheter (Broncus Technologies) was used to create a passage through the wall of three separate segmental bronchi into the adjacent lung parenchyma. An expandable stent, 1.5 cm in length and 3 mm in diameter, was then inserted through each passage. Expiratory volumes were then remeasured as above. In six experiments, two additional stents were then inserted and forced expiratory volumes again determined. Results. The forced expiratory volume in 1 second (FEV1) increased from 245 ± 107 mL at baseline to 447 ± 199 mL after placement of three bronchopulmonary stents (p < 0.001). With two additional stents, the FEV1 increased to 666 + 284 mL (p < 0.001). Conclusions. Creation of extra-anatomic bronchopulmonary passages is a potential therapeutic option for emphysematous patients with marked hyperinflation and severe homogeneous pulmonary destruction.
AB - Background. The crippling effects of emphysema are due in part to dynamic hyperinflation, resulting in altered respiratory mechanics, an increased work of breathing, and a pervasive sense of dyspnea. Because of the extensive collateral ventilation present in emphysematous lungs, we hypothesize that placement of stents between pulmonary parenchyma and large airways could effectively improve expiratory flow, thus reducing dynamic hyperinflation. Methods. Twelve human emphysematous lungs, removed at the time of lung transplantation, were placed in an airtight ventilation chamber with the bronchus attached to a tube traversing the chamber wall, and attached to a pneumotachometer. The chamber was evacuated to -10 cm H2O pressure for lung inflation. A forced expiratory maneuver was simulated by rapidly pressurizing the chamber to 20 cm H2O, while the expiratory volume was continuously recorded. A flexible bronchoscope was then inserted into the airway and a radiofrequency catheter (Broncus Technologies) was used to create a passage through the wall of three separate segmental bronchi into the adjacent lung parenchyma. An expandable stent, 1.5 cm in length and 3 mm in diameter, was then inserted through each passage. Expiratory volumes were then remeasured as above. In six experiments, two additional stents were then inserted and forced expiratory volumes again determined. Results. The forced expiratory volume in 1 second (FEV1) increased from 245 ± 107 mL at baseline to 447 ± 199 mL after placement of three bronchopulmonary stents (p < 0.001). With two additional stents, the FEV1 increased to 666 + 284 mL (p < 0.001). Conclusions. Creation of extra-anatomic bronchopulmonary passages is a potential therapeutic option for emphysematous patients with marked hyperinflation and severe homogeneous pulmonary destruction.
UR - http://www.scopus.com/inward/record.url?scp=0037316908&partnerID=8YFLogxK
U2 - 10.1016/S0003-4975(02)04553-8
DO - 10.1016/S0003-4975(02)04553-8
M3 - Article
C2 - 12607646
AN - SCOPUS:0037316908
SN - 0003-4975
VL - 75
SP - 393
EP - 398
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -