Lung volume reduction surgery

Lung volume reduction surgery is a rarely performed treatment option for heterogeneous emphysema patients with high hyperinflation. Novel semi-invasive and invasive alternatives are being developed, such as bronchial valves for heterogeneous emphysema treatment, and bronchial stents for homogeneous emphysema to reduce counteiproductive collateral ventilation. 

Bullectomy, lung volume reduction surgery, and lung transplantation are surgical options for very severe COPD. These procedures may result in improved spirometry, lung volumes, exercise capacity, dyspnea, health-related quality of life, and possibly survival. Patient selection is critical because not all patients benefit. Refer to the ATS/ERS COPD standards for a detailed discussion of appropriate selection of surgical candidates.1... 

Lung Volume Reduction Surgery for Emphysema, edited by H. E. Fessler, J. J. Reilly, Jr., and D. J. Sugarbaker... 

The practicability of dipyridamole A-ammonia myocardial positron emission tomography for perioperative risk assessment of coronary artery disease in patients with severe chronic obstructive pulmonary disease undergoing lung volume reduction surgery has been studied in 13 men and 7 women (mean age 57 years) without symptoms of coronary artery disease (12). Nine patients had intolerable dyspnea due to bronchoconstriction and required intravenous aminophylline. Dipyridamole cannot be recommended as a pharmacological stress in this setting. 

Levine SM, Peters JI, Jenkinson SG. Lung transplantation and lung volume reduction surgery. In George RB, Light RW, Matfliaw MA, eds. Chest Medicine Essentials of Pulmonary and Critical Care Medicine, 4di ed. Philadelphia, Lippincott Williams Wilkins, 2000 208—232. 

Recent trials have evaluated the effect of bilateral lung volume reduction surgery (LVRS) for management of severe COPD. Short-term trials comparing the effects of pulmonary rehabilitation plus LVRS with pulmonary rehabihtation alone reported that the combination of treatments resulted in greater improvements in lung function, gas exchange, and quahty of life at 3 months. 

Johkoh T, Muller NL, Kavanagh PV et al. Scintigraphic and MR perfusion imaging in preoperative evaluation for lung volume reduction surgery pilot study results. Radiat Med 2000 18 277 281. 

Gierada DS, HaMmian S, Slone RM, Yusen RD. MR analysis of lung volume and thoracic dimensions in patients with emphysema before and after lung volume reduction surgery. AIR Am J Roentgenol 1998 170 707-714. 

Lung Volume Reduction Surgery for Emphysema, edited by H E... 

Figure 7 Twitch transdiaphragmatic pressure elicited by phrenic nerve stimulation (upper panel) and FRC (lowerpanel) in a patient with severe emphysema before (left) and after (right) lung volume reduction surgery. The increase in transdiaphragmatic pressure after surgery was partly due to a decrease in the operating lung volume as demonstrated by the decrease in FRC. Abbreviation FRC, functional residual capacity. Source Data from Ref. 128.

Laghi F, Jubran A, Topeli A, et al. Effect of lung volume reduction surgery on diaphragmatic neuromechanical coupling at 2 years. Chest 2004 125(6) 2188-2195. 

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