Author(s): Shah SS, Goldstraw P
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Abstract The technique first described by Monaldi has been modified for the treatment of discrete emphysematous bullae. Fifty-eight patients (median age, 56 years) underwent this procedure between 1983 and 1992. The operative mortality was 6.9\% (4 patients). Fifty-two patients (89.6\%) noted symptomatic improvement, as measured using the modified Medical Research Council of Great Britain dyspnea scale, from a mean value of 3.7 preoperatively to 2.1 postoperatively. Two patients remained unchanged symptomatically. In all patients, amelioration of symptoms was accompanied by an objective improvement in lung function. A mean increase of 28\% was noted in the forced expiratory volume in 1 second (p < 0.05), and a 12.3\% improvement in the total lung capacity was observed (p < 0.002). The residual lung volume-total lung capacity ratio declined from a mean of 70\% to 57\% after operation. A forced expiratory volume in 1 second of less than 500 mL (p < 0.05) and carbon dioxide tension of greater than 6.5 kPa (p < 0.05) were significant predictors of poor prognosis. The median follow-up period has been 1.9 years (range, 0.5 to 9 years). Two patients have returned for further drainage of new bullae on the operated side, and this was carried out percutaneously in both. We conclude that this technique offers a simple, safe, and effective method for the treatment of discrete bullous disease in patients with emphysema.
This article was published in Ann Thorac Surg
and referenced in Journal of Health & Medical Informatics