title: Endobronchial treatment of giant emphysematous bullae with one-way valves: a new approach for surgically unfit patients.
abstract: OBJECTIVE
  We aimed to evaluate the feasibility and short-term efficacy of endobronchial treatment with one-way valves for giant emphysematous bulla in surgically unfit patients.
  
  
  METHODS
  Nine consecutive patients with giant emphysematous bulla were enrolled in the last 3 years. Endobronchial valves were placed in the segmental bronchi to functionally isolate the airway that supplied the bulla, favouring the deflation of the bulla and its atelectasis. Mean value ± standard deviation of forced expiratory volume in 1s (FEV1), preoperative forced vital capacity (FVC) and residual volume (RV) were: 1.0 ± 0.2l (35 ± 9.9%), 1.5 ± 0.5l (42 ± 12%) and 5.5 ± 0.7 l (23 1 ± 32%), respectively; and the values for diffusion capacity for carbon monoxide was 31 ± 4.6% and for the 6-min walk test (6 MWT) was 156 ± 92 m); all patients required supplemental oxygen at rest. The St. George's Respiratory Questionnaire (SGRQ) score was 85 ± 4.6.
  
  
  RESULTS
  At 24-48 h after the procedure, the mean value of FEV1 (from 35% to 47%, p < 0.01), FVC (from 42% to 52%, p < 0.01), diffusion lung capacity for carbon monoxide (DLCO) (from 31% to 33%, p < 0.05) and 6 MWT (from 156 m to 281 m, p < 0.01) significantly improved with respect to baseline value. Conversely, mean value of total lung capacity (TLC) (from 157% to 123%, p < 0.01) RV (from 231% to 158%, p < 0.01) and SGRQ score (from 85 to 37, p < 0.01) was significantly lower than baseline data; these changes were preserved during the entire follow-up.
  
  
  CONCLUSIONS
  Our preliminary data confirm the feasibility and the potential efficacy of this strategy with significantly immediate improvement of respiration and quality of life, which remains stable during 6 months of follow-up.
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, Naples, Italy. mario.santini@unina2.it
authors.forename: Mario
authors.initials: M
authors.lastname: Santini
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fiorelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vicidomini
authors.forename: Vincenzo Giuseppe
authors.initials: VG
authors.lastname: Di Crescenzo
authors.forename: Gaetana
authors.initials: G
authors.lastname: Messina
authors.forename: Paolo
authors.initials: P
authors.lastname: Laperuta
mesh_terms: D000328:Adult; D000368:Aged; D001768:Blister / Q000000981:diagnostic imaging / Q000601:surgery; D001980:Bronchi / Q000601:surgery*; D002245:Carbon Dioxide / Q000097:blood; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011656:Pulmonary Emphysema / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015656:Respiratory Mechanics / Q000502:physiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen