Expansion thoracoplasty improves respiratory function in a rabbit model of postnatal pulmonary hypoplasia: a pilot study.
METHODS
Using a rabbit model of postnatal pulmonary hypoplasia, we investigated how expansion thoracoplasty affected growth of the spine and lungs.


OBJECTIVE
By constricting the hemithorax in a growing rabbit to create postnatal pulmonary hypoplasia, we quantified how expansion thoracoplasty affects lung volume, respiratory function, alveolar morphology, and spine growth.


BACKGROUND
In children with thoracic insufficiency syndrome, expansion thoracoplasty of the constricted hemithorax improves respiratory function and controls scoliosis. We hypothesize that expansion thoracoplasty of the constricted hemithorax improves pulmonary hypoplasia by allowing the lung to expand, improving respiratory function and stimulating lung growth.


METHODS
Postnatal pulmonary hypoplasia and scoliosis were induced in 5-week old rabbits by constricting left ribs 3 to 8. Expansion thoracoplasty through the fused ribs was performed at 10 weeks. These were compared with Disease rabbits allowed to grow with a constricted left hemithorax and Normal rabbits. Spine and thoracic deformity, right and left lung volumes were measured on reconstructed 3-dimensional computed tomography images and functional residual capacity measured by plethysmography. At maturity, lungs were excised and quantitative histology performed to measure alveolar air fraction and surface density.


RESULTS
Expansion thoracoplasty of the constricted left hemithorax improved scoliosis but increased left lung volumes only moderately compared with Disease rabbits. For Disease and Thoracoplasty Treated rabbits, a compensatory increase in the volume of the right lung maintained total lung volumes equivalent to Normal. Alveolar air space fraction was greater in Disease rabbits, suggestive of emphysema improved by expansion thoracoplasty. Capillaries adjacent to the alveoli were prominent in Thoracoplasty Treated rabbits.


CONCLUSIONS
Expansion thoracoplasty reduces scoliosis and increases the volume of the constricted hemithorax, but the relative increase in the ipsilateral lung volume is small since compensatory hypertrophy of the contralateral lung also occurred. Expansion thoracoplasty may improve respiratory function by increasing alveolar capillaries and preventing emphysematous changes.
Mehta
Hemal P
HP
Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Snyder
Brian D
BD
Baldassarri
Stephen R
SR
Hayward
Melissa J
MJ
Giuffrida
Michael J
MJ
Entezari
Vahid
V
Jackson
Andrew C
AC
D000704:Analysis of Variance; D000818:Animals; D004195:Disease Models, Animal; D005652:Functional Residual Capacity; D008168:Lung / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D009929:Organ Size; D010865:Pilot Projects; D011650:Pulmonary Alveoli / Q000503:physiopathology; D011817:Rabbits; D012120:Respiration Disorders / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012129:Respiratory Function Tests; D012272:Ribs / Q000601:surgery; D012600:Scoliosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000002:abnormalities* / Q000601:surgery; D013905:Thoracoplasty / Q000379:methods*; D013909:Thorax / Q000002:abnormalities* / Q000503:physiopathology; D016896:Treatment Outcome