Abstract
Background. We tried bronchoscopic lung volume reduction (BLVR) with Endobronchial Watanabe Spigot (EWS) for patients with severe emphysema. However, the collateral ventilation seemed to interfere with its clinical effect. Therefore we developed the new endobronchial silicone valve (Endobronchial Miyazawa Valve, EMV) as more effective devise. The purpose of this study was to investigate the safety and feasibility of placing EMV in the lobar bronchi with severe emphysema and giant bulla. Methods. Seven patients (five patients with severe emphysema and two with giant bulla) were entered this pilot study. EMVs were placed in the lobar or segmental bronchi supplying the most hyperinflated parts of the lung. The EMVs were inserted under intravenous anesthesia and spontaneous ventilation, with visual and fluoroscopic control through a flexible bronchoscope and forceps. Spirometry, diffusing capacity of the lung carbon monoxide (D_<LCO>) and exercise tolerance testing (6 minutes walk distance and ADL) were performed at 1 month, 3 months and 6 months after procedure. Results. In this series no complication occurred. In the change ratio of respiratory functions, FVC increased by 7.6±6.7%(p=0.016), FEV_<1.0> increased by 10.1±11.7%(p=0.023), RV/TLC decreased by 18.0±18.9%(p=0.039), D_<LCO>/VA increased by 22.1±24.6%(p=0.008) and 6-min walk distance increased by 48.1±23.7%(p=0.008). ADL was improved slightly or moderately in 6 patients. Three patients revealed the effect of lung volume reduction in the chest X-ray films but no patient had lobar atelectasis. Conclusion. EMV which we developed has a wide orifice for easy excretion of secretion and little risk of damage by its simple structure. Therefore BLVR with EMV can be performed with acceptable short-term safety and worthwhile functional benefits. We considered that BLVR with EMV was the new and low invasive therapy for the patient with severe emphysema or giant bulla. (JJSRE. 2006;28:607-614)
