Source: Annual Congress 2004 - New developments in endobronchial treatment

Abstract

Background: Unilateral complete lobar occlusion with endoscopic valve implants of the most diseased upper lobe may improve ventilation in severe emphysema. But plethysmographic changes post procedure are variable, and individual lung volume changes in inspiration and expiration are unknown. Aim: To assess the CT volumes changes in treated and untreated lungs after single lobe occlusion. Methods: In 15 patients contiguous CT sections of the entire thorax were acquired at full inspiration and expiration before and one month following occlusion of a single most diseased upper lobe. A validated semi automated method was used to isolate the lungs and to calculate each CT lung volume. The plethysmographic volumes were measured within two days of the CT scans. Results: There was a good correlation between CT vital capacity (inspiratory –expiratory difference, VC) and vital capacity (VC) before and after treatment. Post treatment, median VC increased from 2990 ml to 3560 ml. CT- VC increased from 1492 ml to 1794 ml. However, median CT- VC increased in the target lung from 662.1 ml to 847.5 ml, and in the contralateral lung from 751.7 ml to 871.3 ml. The increase in the CT inspiratory volumes of the contralateral lung was statistically significant (p=0.047). Conclusions: Changes in lung volumes in contralateral lung may contribute to the effects of unilateral lobar occlusion with valve implants for emphysema. This effect may explain some mechanisms of benefit post procedure and may need to be considered when deciding targeting strategies for valve implantation.

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T. P. Toma, M. Ujita, D. M. Hansell, D. M. Geddes (London, United Kingdom). Unilateral lobar occlusion with valve implants may change volumes in contralateral emphysematous lung. Eur Respir J 2004; 24: Suppl. 48, 4297

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