Successful operation for bilateral emphysematous giant bullae with severe respiratory failure

Abstract

A 40-year-old male with dyspnea was diagnosed as having bilateral emphysematous bullae. His preoperative state was Hugh-Jones IV dyspnea. Preoperative pulmonary function and blood gas analysis were reduced to VC 960 ml. %VC 25%, FEV _1.0 620 ml, PaO₂ 65 Torr. Pulmonary perfusion scintigraphy showed large defects in the right lung field.
We determined that the right compressed lung tissue could not be expanded after removal of the bulla. The bulla in the left lung was removed in preparation for cardiopulmonary bypass. Pulmonary perfusion scintigraphy showed increased perfusion in the right lung field because of IPPB after the bullectomy. We determined that the right compressed lung tissue could be expanded by removal of the bulla.
He successfully underwent bullectomy on the right. His postoperative condition was good (Hugh-Jones I). Pulmonary function tests and blood gas studies were markedly improved to VC, %VC 84%, FEV _1.0 2170 ml, PaO₂ 72 Torr four months after surgery.