Original article: general thoracicBronchial fenestration improves expiratory flow in emphysematous human lungs
Section snippets
Material and methods
Freshly explanted human lungs from recipients undergoing lung transplantation for emphysema were studied ex vivo. Patient consent was obtained. During explantation, the surgeon paid particular attention to avoid injury of the lungs and thus avoid air leakage from the surface during subsequent testing. The lungs were placed in ice-cold saline, taken immediately to the laboratory, and placed in an airtight ventilating chamber for measurement of forced expiratory flow and volume according to a set
Results
We attempted to study 18 lungs, but in six the air leakage from the surface was less than 400 cc/min and they were not used. The data from the remaining 12 lungs form the basis for this report. In these lungs, the rate of air leakage on inflation to −10 cm of water pressure was an average of 125 cc/min (range 0 to 400 cc). Five of the last six lungs used had no air leakage whatsoever. The repeat measurements of expiratory flow and volume were very reproducible for each lung, with a mean
Comment
In 1930 Van Allen and colleagues [6] obstructed sublobular bronchi in canine lungs and noted no collapse distal to the obstruction. They used the term “collateral inspiration” to explain how “gases may enter one lobule from another in the lung without resorting to known anatomical pathways” [6]. Hogg and associates [4] demonstrated that resistance to collateral airflow in postmortem emphysematous human lungs was low in comparison to normal lungs. They concluded that collateral channels may be
Acknowledgements
The authors acknowledge the expert technical assistance provided by Kathryn Fore, Laura Martini, and Dennis Gordon. This work was supported in part by National Institutes of Health grant R01 (HL62194).
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