Effect of unilateral endobronchial valve insertion on pulmonary ventilation and perfusion: a pilot study.
OBJECTIVE
The effects of bronchoscopic lung volume reduction (BLVR) on pulmonary ventilation and perfusion are incompletely understood. In this pilot trial, we investigated serial changes in regional ventilation and perfusion following unilateral endobronchial valve placement in COPD patients with heterogeneous emphysema.


METHODS
At baseline and at days 30 and 90 following BLVR, subjects underwent lung function, 6MWD and St George's Respiratory Questionnaire. Ventilation and perfusion scintigraphy were performed to quantitate and serially compare regional differences.


RESULTS
Six out of eight subjects completed the study; all had endobronchial valves targeting their left upper lobe. At day 90 post-BLVR, there was a trend towards an increase in FEV(1) and a mean reduction in St George's Respiratory Questionnaire score of nine units. In the targeted left upper zone there was reduced ventilation and perfusion. Ventilation and perfusion to the right lung; and specifically the right lower zone, significantly increased.


CONCLUSIONS
There appears to be redistribution of ventilation and perfusion to the contralateral lung following endobronchial valve placement. This may be of importance when assessing patients for unilateral BLVR. Selecting patients with heterogeneous disease is emphasized, taking into consideration not just comparison between upper and lower lobes, but between left and right lungs. A larger trial is currently underway, guided by these findings.
Chung
Steven C S
SC
Department of Thoracic Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia. stev78@optusnet.com.au
Peters
Matthew J
MJ
Chen
Stephanie
S
Emmett
Louise
L
Ing
Alvin J
AJ
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011013:Pneumonectomy / Q000295:instrumentation* / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D012123:Pulmonary Ventilation; D011859:Radiography; D016896:Treatment Outcome