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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

Collateral ventilation.Notes: Schematic figure illustrating the role of intra- and interlobar collateral ventilation, and the implications for bronchoscopic lung volume reduction using one-way endobronchial valves. The interlobar collateral ventilation from the left upper to the left lower lobe, impedes the desired atelectasis of the lower lobe. Because all segments of the left lower lobe have endobronchial valves, intralobar collateral ventilation does not influence the development of atelectasis.
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f2-copd-11-765: Collateral ventilation.Notes: Schematic figure illustrating the role of intra- and interlobar collateral ventilation, and the implications for bronchoscopic lung volume reduction using one-way endobronchial valves. The interlobar collateral ventilation from the left upper to the left lower lobe, impedes the desired atelectasis of the lower lobe. Because all segments of the left lower lobe have endobronchial valves, intralobar collateral ventilation does not influence the development of atelectasis.

Mentions: Obviously, interlobar CV is an important factor in BLVR therapy, as this therapy is based on complete atelectasis of a lobe (Figure 2). Most probably, incomplete fissures are responsible for the interlobar collateral flow, although not found in every study regarding this subject.6,15 There is no literature regarding the mechanism of CV in incomplete fissures between lobes. It can be assumed that the mechanism of collateral flow between lobes is the same as within a lobe.


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

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

Collateral ventilation.Notes: Schematic figure illustrating the role of intra- and interlobar collateral ventilation, and the implications for bronchoscopic lung volume reduction using one-way endobronchial valves. The interlobar collateral ventilation from the left upper to the left lower lobe, impedes the desired atelectasis of the lower lobe. Because all segments of the left lower lobe have endobronchial valves, intralobar collateral ventilation does not influence the development of atelectasis.
© Copyright Policy
Related In: Results  -  Collection

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

f2-copd-11-765: Collateral ventilation.Notes: Schematic figure illustrating the role of intra- and interlobar collateral ventilation, and the implications for bronchoscopic lung volume reduction using one-way endobronchial valves. The interlobar collateral ventilation from the left upper to the left lower lobe, impedes the desired atelectasis of the lower lobe. Because all segments of the left lower lobe have endobronchial valves, intralobar collateral ventilation does not influence the development of atelectasis.
Mentions: Obviously, interlobar CV is an important factor in BLVR therapy, as this therapy is based on complete atelectasis of a lobe (Figure 2). Most probably, incomplete fissures are responsible for the interlobar collateral flow, although not found in every study regarding this subject.6,15 There is no literature regarding the mechanism of CV in incomplete fissures between lobes. It can be assumed that the mechanism of collateral flow between lobes is the same as within a lobe.

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