A case of bilateral emphysematous bullae treated by video-assisted thoracic surgery, resulting in remarkable improvements in pulmonary function

Abstract

A 48-year-old man with moderate dyspnea (Hugh-Jones III) and bilateral giant emphysematous bullae (total volume, about one half of the left thoracic cavity) underwent video-assisted thoracoscopic surgery (VATS) of the left-sided giant emphysematous bullae. In spite of pressure limiting ventilation without nitrogen oxide during surgery, the patient developed severe respiratory failure due to right-sided over-inflation and atelectasis. The respiratory failure gradually resolved with spontaneous respiration and we decided not to perform the contralateral, emergency surgery under ECMO. He was extubated on the first postoperative day, moved from the intensive care unit on the third postoperative day, and discharged in good condition on the eighteenth postoperative day. Two months later, he underwent elective VATS for the right-sided giant emphysematous bullae. Postoperatively, pulmonary function was significantly improved and his dyspnea disappeared (Hugh-Jones I).