title: Lung function after bilateral lower lobe lung volume reduction surgery for alpha1-antitrypsin emphysema.
abstract: This study explores the mechanism(s) of airflow limitation following lung volume reduction surgery (LVRS) in patients with emphysema due to homozygous alpha1-antitrypsin (AT) deficiency. Bilateral targeted lower lobe stapled LVRS using video thoracoscopy was performed in six patients (five males) aged 61+/-9 yrs (mean+/-SD) with alpha1-AT emphysema. Two patients received only a 6-month follow-up. However, four patients, at 22, 24, 27 and 36 months post-LVRS, noted relief from dyspnoea and increased walk tolerance. At 27+/-6 months (mean+/-SD) post-LVRS, their forced expiratory volume in one second improved only from 30+/-2% of the predicted value (mean+/-SEM) before surgery to 33+/-1% pred after surgery. Yet, total lung capacity (TLC) decreased from 151+/-13 to 127+/-10% pred; diffusing capacity increased from 35+/-9 to 59+/-9% pred; and vital capacity increased from 68+/-10 to 88+/-5% pred. In three patients, static lung elastic recoil at TLC increased from 1.1+/-0.15 to 1.2+/-0.10 kPa. Using flow/pressure curves, the mechanism for expiratory airflow limitation pre-LVRS and the improvement noted post-LVRS could be primarily accounted for by the initial loss and subsequent increase in lung elastic recoil. Bilateral lung volume reduction surgery provides modest physiologic improvement for 2-3 yrs in patients with alpha1-antitrypsin emphysema due to increases in lung elastic recoil.
authors.affiliation: Dept of Medicine, Lakewood Regional Medical Center, School of Medicine, University of California, Los Angeles, USA.
authors.forename: A F
authors.initials: AF
authors.lastname: Gelb
authors.forename: R J
authors.initials: RJ
authors.lastname: McKenna
authors.forename: M
authors.initials: M
authors.lastname: Brenner
authors.forename: R
authors.initials: R
authors.lastname: Fischel
authors.forename: N
authors.initials: N
authors.lastname: Zamel
mesh_terms: D004417:Dyspnea / Q000503:physiopathology; D004548:Elasticity; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D011379:Prognosis; D011656:Pulmonary Emphysema / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D013906:Thoracoscopy; D014109:Total Lung Capacity; D014741:Video Recording; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications*