Background: New bronchoscopic techniques for end-stage emphysema treatment are nowadays available; the presence of interlobar collateral ventilation (CV) and interlobar lung fissures (ILF) is crucial for patient selection. Objectives: Assessment of these variables has been reported previously, but it has never been anatomically validated in vivo. This is the purpose of our study. Methods: Twenty-one patients undergoing lung resection for lung cancer were prospectively enrolled in this study. At operation, CV was assessed by the Chartis® catheter system. ILF completeness at high-resolution computed tomography (HRCT) was retrospectively reviewed. The ILF status at HRCT and at surgery was compared; furthermore, the relationship between CV and ILF status was assessed. Results: At HRCT, ILF were incomplete in 18 cases; at catheter evaluation, CV was present in 11 cases; 15 patients had incomplete ILF at operation. HRCT specificity, sensitivity and accuracy were 33, 93 and 76% compared with ILF status at surgery. HRCT accuracy was 90% on the right and 63% on the left. We demonstrated a high grade of probability of CV presence and incomplete ILF at surgery (odds ratio = 10.0). Conclusions: There is a correlation between ILF status and CV. Both catheter evaluation of CV and HRCT assessment of ILF show some limitations. However, the cumulative information provided by these techniques allows to reliably assess the anatomical ILF status.

Keywords:
Airway bypass, Bronchoscopic lung volume reduction, Collateral lung ventilation, Emphysema, Interlobar fissures
1.
Reilly J, Washko G, Pinto-Plata V, Velez E, Kenney L, Berger R, Celli B: Biological lung volume reduction. A new bronchoscopic therapy for advanced emphysema. Chest 2007;131:1108-1113.
2.
Herth FJ, Eberhard RE, Gompelmann D, Slebos DJ, Ernst A: Bronchoscopic lung volume reduction with a dedicated coil: a clinical pilot study. Ther Adv Respir Dis 2010;4141:225-231.
3.
Emery MJ, Eveland RL, Evelandt K, Couetil LL, Hildebrandt J, Swenson ER: Lung volume reduction by bronchoscopic administration of steam. Am J Respir Crit Care Med 2010;182:1282-1291.
4.
Rendina EA, De Giacomo T, Venuta F, Coloni GF, Meyers BF, Patterson GA, Cooper JD: Feasibility and safety of the airway by-pass procedure for patients with emphysema. J Thorac Cardiovasc Surg 2003;125:1294-1299.
5.
Venuta F, De Giacomo T, Rendina EA, Ciccone AM, Diso D, Perrone A, Parola D, Anile M, Coloni GF: Bronchoscopic lung volume reduction with one way valves in patients with heterogeneous emphysema. Ann Thorac Surg 2005;79:411-416.
6.
Venuta F, Rendina EA, De Giacomo T, Anile M, Diso D, Andreetti C, Pugliese F, Coloni GF: Bronchoscopic procedures for emphysema treatment. Eur J Cardiothorac Surg 2006;29:281-287.
7.
Venuta F, Anile M, Diso D, Carillo C, De Giacomo T, D'Andrilli A, Fraioli F, Rendina EA, Coloni GF: Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema. Eur Respir J 2012;39:1084-1089.
8.
Sciurba FC, Ernst A, Herth FJF, Strange C, Criner GJ, Marquette CH, Kovitz KL, Chiacchierini RF, Goldin J, Mc Lennon G; Vent Study Research Group: A randomized study of endobronchial valves for advanced emphysema. N Engl J Med 2010;363:1233-1244.
9.
Venuta F, Diso D, Anile M, De Giacomo T, Rendina EA, Rolla M, Ricella C, Coloni GF: Bronchoscopic lung volume reduction as a bridge to lung transplantation in patients with chronic obstructive pulmonary disease. Eur J Cardiothorac Surg 2011;39:364-367.
10.
Cetti EJ, Moore AJ, Geddes DM: Collateral ventilation. Thorax 2006;61:371-373.
11.
Shah PL, Slebos DJ, Cardoso PFG, Cetti E, Voelker K, Levine B, Russell ME, Goldin J, Brown M, Cooper JD, Sybrecht GW; EASE trial study group: Bronchoscopic lung-volume reduction with Exhale airway stents for emphysema (EASE trial): randomized, sham-controlled, multicenter trial. Lancet 2011;378:997-1005.
12.
Herth FGF, Eberhardt R, Gompelmann D, Ficker H, Wagner M, Ek L, Schmidt B, Slebos DJ: Radiological and clinical outcomes of using Chartis to plan endobronchial valve treatment. Eur Respir J 2013;41:302-308.
13.
Ozmen CA, Nazaroglu H, Bayrak AH, Senturk S, Akay HO: Evaluation of interlobar and accessory pulmonary fissures on 64-row MDTC. Clin Anat 2010;23:552-558.
14.
Pu J, Fuhrman C, Durick J, Leader JK, Klym A, Sciurba FC, Gur D: Computerized assessment of pulmonary fissure integrity using high resolution CT. Med Phys 2010;37:4661-4672.
15.
Aljury N, Freitag L: Validation and pilot study of a new bronchoscopic method to measure collateral ventilation before endobronchial lung volume reduction. J Appl Physiol 2009;106:774-783.
16.
Gompelmann D, Eberhardt R, Michaud G, Ernst A, Herth FJ: Predicting atelectasis by assessment of collateral ventilation prior to endobronchial lung volume reduction: a feasibility study. Respiration 2010;80:419-425.
17.
Mantri S, Macarag C, Shetty S, Aljury N, Herth F, Eberhardt R, Ernst A: Technical advances: measurement of collateral flow in the lung with a dedicated endobronchial catheter system. J Bronchology Interv Pulmonol 2009;16:141-144.
18.
Salanitri J, Kalff V, Kelly M, Halsworth L, Williams T, Snell G: 133Xenon ventilation scintigraphy applied to bronchoscopic lung volume reduction techniques for emphysema: relevance of interlobar collaterals. Intern Med J 2005;35:97-103.
19.
Morrell NW, Wignall BK, Biggs T, Seed WA: Collateral ventilation and gas exchange in emphysema. Am J Respir Crit Care Med 1994;150:635-643.
20.
Terry PB, Traystman RJ, Neball HH: Collateral ventilation in man. N Engl J Med 1978;298:10-15.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.