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(Chest. 2007;131:214-216.)
© 2007 American College of Chest Physicians

Use of Endobronchial Valves for Native Lung Hyperinflation Associated With Respiratory Failure in a Single-Lung Transplant Recipient for Emphysema*

Maria M. Crespo, MD; Bruce A. Johnson, MD; Kenneth R. McCurry, MD; Rodney J. Landreneau, MD, FCCP and Frank C. Sciurba, MD, FCCP

* From the Divisions of Pulmonary, Allergy and Critical Care Medicine (Drs. Crespo, Johnson, and Sciurba) and Cardiothoracic Surgery (Drs. McCurry and Landreneau).University of Pittsburgh, Pittsburgh, PA.

Correspondence to: Maria M. Crespo, MD, University of Pittsburgh Medical Center, Division of Pulmonary, Allergy and, Critical Care Medicine, NW 628 Montefiore University Hospital, 3459 Fifth Ave, Pittsburgh, PA 15213; e-mail: crespomm{at}upmc.edu

Abstract

Emphysema is a common indication for adult pulmonary transplantation. Double-lung transplantation is increasingly the preferred approach because severe posttransplant native lung hyperinflation (NLH) following single-lung transplantation may compromise allograft lung function. We describe successful emergency use of bronchoscopic lung volume reduction using endobronchial valves (EBVs) [Zephyr; Emphasys Medical; Redwood, CA] in a single-lung transplant recipient who was critically ill with ventilator dependence from complications of NLH and at excessive risk for lung volume reduction surgery or pneumonectomy. Following placement of 17 valves in all segments of the native lung, atelectasis of the native lung was accompanied by volume expansion of the allograft. Immediately following valve placement, peak airway pressure decreased and alveolar ventilation increased. The patient was subsequently weaned from mechanical ventilation. This report suggests the need for clinical trials to evaluate the effectiveness of EBVs in single-lung transplant recipients with less critical functional impairment associated with NLH.

Key Words: bronchoscopy • emphysema • endobronchial valve • lung transplant • native lung hyperinflation • volume reduction






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