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• W4387247952 abstract "SESSION TITLE: Procedures Case Report Posters 8 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Bronchoscopic lung volume reduction (BLVR) using one-way endobronchial valves (EBVs) can be used to treat refractory dyspnea due to air trapping, hyperinflation, and impaired gas exchange, in eligible candidates with chronic obstructive pulmonary disease (COPD), by achieving lobar atelectasis. We identified a patient with severe emphysema without interlobar collateral ventilation who underwent left upper lobe (LUL) BLVR followed by stable LUL atelectasis, presenting two years later with spontaneous re-expansion of the atelectatic lobe. CASE PRESENTATION: A 69-year-old man with a history of severe emphysema on maximal medical regimen, presented to our clinic for BLVR evaluation. He endorsed dyspnea, productive cough, and wheezing. His spirometry showed FEV1 30%, RV 223%, TLC 124%, DLCO 45% predicted, and a six-minute walk distance of 464 m. A CT chest volumetric StratX® analysis showed a destruction score of 50% in his LUL, 90% fissure completeness on the left, and a projected decrease of 1894 mL of lung volume post LUL BLVR. Two Zephyr EBVs were placed in the apicoposterior and anterior segments of the LUL after confirmation by balloon occlusion. Follow up CT scans showed EBV placement with no associated atelectasis, but major fissures appeared complete. One year later, the patient presented with worsening dyspnea and hemoptysis, and a repeat StratX® analysis revealed valve leaks. Therefore, EBVs were removed via bronchoscopy, and argon plasma coagulation of bleeding granulation was performed to achieve hemostasis. BLVR revision was then performed using two 5.5 LP EBVs. A subsequent chest CT at 6-week follow-up showed stable left EBVs with complete left upper lobe collapse. Spirometric flows showed sustained improvement at 8 months with FEV1 39%, RV 156%, and TLC 102% predicted. Close follow-up was continued with serial CT scans. However, 2 years after his BLVR revision, his chest CT showed aeration of the LUL, with a small, left pneumothorax. Due to his partial BLVR reversal, the patient is being closely monitored, and BLVR revision is being considered. DISCUSSION: EBVs significantly improve pulmonary function and exercise capacity in patients with severe emphysema and no interlobar collateral ventilation [1,2]. A multicenter RCT by Criner et al [3] added that the Zephyr EBV has an acceptable safety profile and its benefits last at least 12 months. However, data regarding long-term outcomes of BLVR are lacking. We describe a case of spontaneous reversal of atelectasis 2 years after a successful BLVR revision, in a patient with severe emphysema and complete fissures. The underlying cause for this re-expansion is unclear, and may be due to the formation of collateral ventilation pathways. CONCLUSIONS: This case report highlights the potential for spontaneous reversal of BLVR and the need for long-term follow-up after the procedure. Close monitoring and follow-up of patients undergoing BLVR is warranted to detect and manage potential long-term sequelae and assess the durability of the procedure. REFERENCE #1: Sciurba FC, Ernst A, Herth FJF, et al. A Randomized Study of Endobronchial Valves for Advanced Emphysema. N Engl J Med. 2010;363(13):1233-1244. REFERENCE #2: Klooster K, ten Hacken NHT, Hartman JE, Kerstjens HAM, van Rikxoort EM, Slebos DJ. Endobronchial Valves for Emphysema without Interlobar Collateral Ventilation. N Engl J Med. 2015;373(24):2325-2335 REFERENCE #3: Criner GJ, Sue R, Wright S, et al. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE). Am J Respir Crit Care Med. 2018;198(9):1151-1164. DISCLOSURES: No relevant relationships by Mohieddin Albarazi No relevant relationships by Abid Khokar No relevant relationships by Andres Latorre-Rodriguez No relevant relationships by Amy Moore No relevant relationships by Ali Saeed No relevant relationships by Devika Sindu No relevant relationships by Ragul Yuvaraj" @default.
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• W4387247952 date "2023-10-01" @default.
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• W4387247952 title "SPONTANEOUS REVERSAL OF BRONCHOSCOPIC LUNG VOLUME REDUCTION AFTER 2 YEARS" @default.
• W4387247952 doi "https://doi.org/10.1016/j.chest.2023.07.3490" @default.
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