Cardio-Pulmonary Function in Bullous Emphysema: A Preliminary Report

Abstract

SUMMARY The development of pulmonary hypertension is dependent upon an increase in pulmonary resistance. Factors influencing the increase in pulmonary resistance are destruction of small vascular channels, anoxia, arteriolar constriction, polycythemia, hypervolemia, and increased cardiac output. Three patients with diffuse obstructive emphysema associated with giant unilateral bullae have been observed pre- and post-operatively following resection of emphysematous bullae. Two of the patients were first observed with episodes of right heart failure. Post-operatively there was an increase in vital capacity in all three patients and an increase in maximum breathing capacity in two. In the two patients who had cardiac catheterization performed, both before and after surgery, there was a fall in pulmonary artery pressure in both and an increase in arterial oxygen saturation in one following resection of the bullae. All patients tolerated surgery without development of complications and were able to return to their former occupations. The two with heart failure were maintained in a state of adequate cardiac compensation on an ambulatory basis. The follow-up period has ranged from seven to 22 months. The clinical improvement of these patients seems to correlate with the reduction of pulmonary artery pressure although the exact mechanism is not apparent. Further studies are in progress to more fully evaluate the results.