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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

Implanted one-way endobronchial valve.Notes: (A) Open valve, allowing trapped air and fluids to escape. (B) Closed valve, no air or fluids can enter the valve.
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f4-copd-11-765: Implanted one-way endobronchial valve.Notes: (A) Open valve, allowing trapped air and fluids to escape. (B) Closed valve, no air or fluids can enter the valve.

Mentions: For optimal result and reliability of the Chartis measurement, there are several technical aspects to consider. For example, coughing or multiple mucus plugs might impede the measurement. Furthermore, especially in the lower lobes, the balloon might occlude a segment – for example, B6 in the left lower lobe – so that this segment may not get included in the assessment of CV. Moreover, dynamic airway collapse can occur, which might show as an abrupt or gradual ending of flow, with <100 mL of total exhaled air. To maximize the chance of a successful and reliable measurement, adequate training is required.37,43,45,46 Furthermore, the measurement can be performed under general anesthesia with positive pressure support (Figure 3E), or high frequency jet ventilation. This creates optimal circumstances for a reliable and fast measurement, and if there is no CV, the treatment with EBVs can take place immediately, in the same treatment session (Figure 4).


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

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

Implanted one-way endobronchial valve.Notes: (A) Open valve, allowing trapped air and fluids to escape. (B) Closed valve, no air or fluids can enter the valve.
© Copyright Policy
Related In: Results  -  Collection

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

f4-copd-11-765: Implanted one-way endobronchial valve.Notes: (A) Open valve, allowing trapped air and fluids to escape. (B) Closed valve, no air or fluids can enter the valve.
Mentions: For optimal result and reliability of the Chartis measurement, there are several technical aspects to consider. For example, coughing or multiple mucus plugs might impede the measurement. Furthermore, especially in the lower lobes, the balloon might occlude a segment – for example, B6 in the left lower lobe – so that this segment may not get included in the assessment of CV. Moreover, dynamic airway collapse can occur, which might show as an abrupt or gradual ending of flow, with <100 mL of total exhaled air. To maximize the chance of a successful and reliable measurement, adequate training is required.37,43,45,46 Furthermore, the measurement can be performed under general anesthesia with positive pressure support (Figure 3E), or high frequency jet ventilation. This creates optimal circumstances for a reliable and fast measurement, and if there is no CV, the treatment with EBVs can take place immediately, in the same treatment session (Figure 4).

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