A novel, multidisciplinary, approach to the management of refractory bronchopleural fistula using a one-way endobronchial valve.
Emergent approval was obtained from our Internal Review Board for the use of an endobronchial valve to obstruct the segmental bronchus leading to the site of a bronchopleural fistula. The patient had a persistent air leak and empyema despite aggressive therapy with antibiotics, thoracotomy with a muscle flap and tisseal closure. In the operating theater, rigid bronchoscopy was performed under general anesthesia, and the exact location of the bronchopleural fistula was identified. A guidewire was placed under vision, and a small size endobronchial valve (Emphasys Medical Inc., Redwood City, CA) was loaded, inserted and deployed into the involved airway with excellent fit. The segmental bronchus was then identified by thoracic surgery and a latissimus dorsi muscle flap was again used to buttress the fistula and fill the pleural cavity.
Our new approach resulted in complete healing of the bronchopleural fistula, resolution of the empyema, and complete success of the surgical repair.
We conclude that the placement of an endobronchial valve can prevent persistent air leak in the setting of refractory bronchopleural fistula.
A multi-disciplinary approach to the treatment of refractory bronchopleural fistula is necessary. Further studies are required to define the role of segmental bronchial occlusion for patients with this disease.
Rabih Bechara, Product/procedure/technique that is considered research and is NOT yet approved for any purpose. Endobronchial valves (Emphasys Medical Inc., Redwood City California) are currently approved for endoscopic lung volume reduction in Europe, and are currently being investigated in the United States. This abstract presents a novel use, which was approved.