Expiratory flow pattern following single-lung transplantation in emphysema.
In single lung transplantation (SLT) recipients, a "plateau" of the maximal expiratory flow volume curve (MEFV) and a "biphasic" MEFV have been reported to reflect anastomosis pathology. A plateau is defined as constant airflow over a large expired volume early in the MEFV. A biphasic MEFV has an initial period of high flow followed by a terminal low flow phase. Models of expiratory flow limitation by wave speed, however, predict that the MEFV of SLT recipients with emphysema should both be biphasic and demonstrate a plateau even without anastomosis pathology. Review of the spirometries and clinical courses of our first ten patients receiving SLT for emphysema demonstrated a biphasic MEFV, and a plateau of the MEFV in all patients. No patient showed evidence of anastomosis pathology. Independent lung spirometries, generated by a novel technique, revealed that the initial high flow phase of the MEFV came from the transplanted lung and the terminal low flow from the native emphysematous lung. The location of the flow limitation was demonstrated to be immediately downstream from the anastomosis. Therefore, the MEFV of SLT recipients with emphysema routinely demonstrates both a biphasic pattern and a plateau, neither of which necessarily reflect anastomosis pathology.
Lung Transplantation Program, Massachusetts General Hospital, Boston 02114.
J P
JP
Herlihy
J G
JG
Venegas
D M
DM
Systrom
R E
RE
Greene
K A
KA
McKusick
J C
JC
Wain
L C
LC
Ginns
D001999:Bronchoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D016040:Lung Transplantation / Q000000981:diagnostic imaging / Q000502:physiology*; D008297:Male; D008449:Maximal Expiratory Flow-Volume Curves; D008875:Middle Aged; D011184:Postoperative Period; D011656:Pulmonary Emphysema / Q000503:physiopathology* / Q000601:surgery; D015656:Respiratory Mechanics / Q000502:physiology*; D013147:Spirometry; D014057:Tomography, X-Ray Computed