Bilateral endoscopic volume reduction in a woman with severe emphysema.

In selected patients with severe heterogenous emphysema lung volume reduction can be performed by using endobronchial valves. So far, only unilateral procedures have been published. Here is described a patient where a right-sided closure of the right upper lobe resulted in an increase of FEV1sec of more than 50%, and some years later the procedure was repeated on the left side with further considerable improvement. A tracheal bronchus to the apical segment of the right upper lobe made measuring the collateral flow at bronchoscopy impossible, but clearly visible fissures were used as a substitute. In conclusion, valve treatment in suitable patients can give substantial improvement in lung function and quality of life and can be repeated on the other side if warranted some years later.