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The fissure: interlobar collateral ventilation and implications for endoscopic therapy in emphysema.

Koster TD, Slebos DJ - Int J Chron Obstruct Pulmon Dis (2016)

Bottom Line: The Chartis system is an endobronchial method to directly measure the presence of collateral ventilation.Both methods have unique value, and the combination of both can accurately predict the treatment response to the bronchoscopic placement of endobronchial valves.This review provides an in-depth view of lung fissure and collateral ventilation to help understand its importance in selecting the appropriate patients for new emphysema treatments and thus avoid useless treatment in unsuitable patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

ABSTRACT
In patients with severe emphysema, bronchoscopic lung volume reduction using one-way valves is a promising therapeutic option to improve lung function and quality of life. The goal of this treatment is to achieve a complete lobar atelectasis. In a significant proportion of patients, this atelectasis cannot be achieved due to interlobar collateral ventilation. This collateral ventilation is generated through incomplete lobar fissures. Therefore, only patients with complete fissures and no collateral ventilation can be selected for endobronchial therapy with one-way valves. Incomplete fissures are very common and exhibit a great variation in anatomy. The reported prevalence is 17%-85% for the right major fissure, 19%-74% for the left major fissure, and 20%-90% for the minor fissure. There are several methods of measuring or predicting the presence of collateral ventilation, with computed tomography (CT)-fissure analysis and the Chartis measurement being the most important. CT-fissure analysis is an indirect method to measure the completeness of fissures as a surrogate for collateral ventilation. The Chartis system is an endobronchial method to directly measure the presence of collateral ventilation. Both methods have unique value, and the combination of both can accurately predict the treatment response to the bronchoscopic placement of endobronchial valves. This review provides an in-depth view of lung fissure and collateral ventilation to help understand its importance in selecting the appropriate patients for new emphysema treatments and thus avoid useless treatment in unsuitable patients.

No MeSH data available.


Related in: MedlinePlus

Three different pathways for collateral ventilation.Notes: Interalveolar ventilation through the pores of Kohn. Bronchiole–alveolar ventilation through channels of Lambert. Interbronchiolar ventilation through channels of Martin.
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f1-copd-11-765: Three different pathways for collateral ventilation.Notes: Interalveolar ventilation through the pores of Kohn. Bronchiole–alveolar ventilation through channels of Lambert. Interbronchiolar ventilation through channels of Martin.

Mentions: There are three main candidate pathways for CV to take place (Figure 1). The first described pathway consists of interalveolar communication of air through the pores of Kohn. These are situated in alveolar walls and should permit the passage of fluid and possibly air. However, these pores are small (<5 μm) and very high pressures (estimated 19.2 kPa or 196 cmH2O) would be necessary for air transport.9–13 A second possible pathway is through accessory communication channels (30 μm in diameter) between distal bronchioles and alveoli, as described by Lambert.14 The third pathway is described by Martin13 and contains accessory respiratory bronchioles between the bronchioles of adjacent lung segments. This pathway is probably the most important pathway, due to the larger size (80–150 μm) of bronchioles and thus having a lower resistance when compared to the other pathways.12,13,15


The fissure: interlobar collateral ventilation and implications for endoscopic therapy in emphysema.

Koster TD, Slebos DJ - Int J Chron Obstruct Pulmon Dis (2016)

Three different pathways for collateral ventilation.Notes: Interalveolar ventilation through the pores of Kohn. Bronchiole–alveolar ventilation through channels of Lambert. Interbronchiolar ventilation through channels of Martin.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835138&req=5

f1-copd-11-765: Three different pathways for collateral ventilation.Notes: Interalveolar ventilation through the pores of Kohn. Bronchiole–alveolar ventilation through channels of Lambert. Interbronchiolar ventilation through channels of Martin.
Mentions: There are three main candidate pathways for CV to take place (Figure 1). The first described pathway consists of interalveolar communication of air through the pores of Kohn. These are situated in alveolar walls and should permit the passage of fluid and possibly air. However, these pores are small (<5 μm) and very high pressures (estimated 19.2 kPa or 196 cmH2O) would be necessary for air transport.9–13 A second possible pathway is through accessory communication channels (30 μm in diameter) between distal bronchioles and alveoli, as described by Lambert.14 The third pathway is described by Martin13 and contains accessory respiratory bronchioles between the bronchioles of adjacent lung segments. This pathway is probably the most important pathway, due to the larger size (80–150 μm) of bronchioles and thus having a lower resistance when compared to the other pathways.12,13,15

Bottom Line: The Chartis system is an endobronchial method to directly measure the presence of collateral ventilation.Both methods have unique value, and the combination of both can accurately predict the treatment response to the bronchoscopic placement of endobronchial valves.This review provides an in-depth view of lung fissure and collateral ventilation to help understand its importance in selecting the appropriate patients for new emphysema treatments and thus avoid useless treatment in unsuitable patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

ABSTRACT
In patients with severe emphysema, bronchoscopic lung volume reduction using one-way valves is a promising therapeutic option to improve lung function and quality of life. The goal of this treatment is to achieve a complete lobar atelectasis. In a significant proportion of patients, this atelectasis cannot be achieved due to interlobar collateral ventilation. This collateral ventilation is generated through incomplete lobar fissures. Therefore, only patients with complete fissures and no collateral ventilation can be selected for endobronchial therapy with one-way valves. Incomplete fissures are very common and exhibit a great variation in anatomy. The reported prevalence is 17%-85% for the right major fissure, 19%-74% for the left major fissure, and 20%-90% for the minor fissure. There are several methods of measuring or predicting the presence of collateral ventilation, with computed tomography (CT)-fissure analysis and the Chartis measurement being the most important. CT-fissure analysis is an indirect method to measure the completeness of fissures as a surrogate for collateral ventilation. The Chartis system is an endobronchial method to directly measure the presence of collateral ventilation. Both methods have unique value, and the combination of both can accurately predict the treatment response to the bronchoscopic placement of endobronchial valves. This review provides an in-depth view of lung fissure and collateral ventilation to help understand its importance in selecting the appropriate patients for new emphysema treatments and thus avoid useless treatment in unsuitable patients.

No MeSH data available.


Related in: MedlinePlus