Allergy and Airway |

Novel Therapy for Persistent Air Leak FREE TO VIEW

Killol Patel, MD; Navneet Arora, MD; Chaitali Gupte, MD; Irtza Sharif, MD; Pratik Patel, MD
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Newark Beth Israel Medical Center, Newark, NJ

Chest. 2013;144(4_MeetingAbstracts):16A. doi:10.1378/chest.1705220
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SESSION TITLE: Bronchology Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Persistent pulmonary air leaks (PAL) is one of the indications for prolonged chest tube placement which itself is associated with significant morbidity, mortality and increased length of stay. The usual approach is to do a thoracoscopic or open surgical repair, however this can now be achieved with minimally invasive approach using IBV (Intra Bronchial Valve). We present a first case in which the PAL was treated with noninvasive pneumonectomy by placement of IBV valves.

CASE PRESENTATION: Our patient is an 84 y/o male with past medical history of Chronic Obstructive Pulmonary Disease, ischemic heart disease who presented with recurrent right sided pleural effusions as complication of abdominal aortic aneurysm repair. He had a chest tube placed for these recurrent effusions which was complicated by PAL however because of his cardio-pulmonary co-morbidities he wasn’t a candidate for open surgical repair. He had a V/Q scan to see the functional status of his lungs and was found to have differential perfusion of 88% to the Left lung and 12% to the Right lung. Patient had fiber optic bronchoscopy and the right upper lobe was occluded using IBV, however he continued to have diminished but persistent airleak for subsequent three days. He again underwent bronchoscopy and his entire right lung was occluded using nine IBV valves, effectively performing a non-invasive pneumonectomy for his poorly functioning lung, with no air leak identified on the water seal. Patient’s chest tube was discontinued the next day and he was discharged home subsequently. He was noted to be doing well in a follow-up visit.

DISCUSSION: The IBV valves are currently used as humanitarian device and currently under investigation for their use in PAL. There are currently multiple case reports in the literature demonstrating the use of IBV valves for PAL by occluding several segments in the lung however we couldn’t find any cases describing a total occlusion of a lung. By performing a non-invasive pneumonectomy on our patient we were able to improve his quality of life as well as decrease the co-morbities associated with PAL.

CONCLUSIONS: IBV valves can be used as one of the therapeutic options for minimally invasive treatment option for PAL.

Reference #1: Sterman DH et al. A multicenter pilot study of a bronchial valve for the treatment of severe emphysema. Respiration 2010;79:222-33.

Reference #2: Travaline J et al. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest. 2009;136:355-60.

DISCLOSURE: The following authors have nothing to disclose: Killol Patel, Navneet Arora, Chaitali Gupte, Irtza Sharif, Pratik Patel

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