New Treatment For Leaky Lungs -- In Depth Doctor's Interview
Eric Sommers, M.D., a cardiothoracic surgeon at Tampa General Hospital discusses a new way to repair leaky lungs.
What is leaky lung and how does this happen?
Dr. Eric Sommers: Leaky lung is a general term that we use for what happens to some patients following lung surgery. As you can imagine, any operation on the lung comes with risk and potential problems just as it does with any other type of surgery. The lung, by its nature, as it heals, will leak varying amount of fluid or air and the leaky lung that we are talking about is really a natural consequence of any operation on the lungs. In the vast majority of patients the leak heals as any tissue would heal and as the lung heals the air leak resolves and the patient goes home and lives their life naturally. In a small percentage of patients after lung surgery the air leak actually persists and becomes a more serious problem and can leave the patient staying several more days in the hospital than normal and, in some instances, very rarely, would require the patient to go back to the operating room and have another surgery to repair the leak.
Is this essentially a hole in their lung?
Dr. Eric Sommers: In some cases yes. It’s that simple: it’s a hole in the lung. It could be due to several different reasons. One would be an air pipe, or air tube, that’s been cut or stapled during the surgery that doesn’t heal normally, or it could be the lung tissue itself that is leaking air.
And what does that mean for the patient? Do they have trouble breathing?
Dr. Eric Sommers: Normally, the patient feels very little in the way of symptoms from this because the air that leaks out of the lung is normally drained through a tube that all patients get after surgery, but the problem is, of course, we can’t remove that tube until the air leak resolves and so they spend time in the hospital waiting for that air leak to heal with a tube in their side.
In Mr. Austin’s case, I guess the hole didn’t heal itself and he couldn’t handle another surgery. Can you tell me about that?
Dr. Eric Sommers: Mr. Austin’s case is a very unique case in that he had a very severe heart problem that prevented the usual approach to his complication, which would have been another extensive operation. So, in lieu of that, they had been managing his leak by actually packing the hole in his side, which would prevent him from becoming gravely ill, but, of course, that is not something someone wants to live with permanently.
How big was the hole in his lung?
Dr. Eric Sommers: His problem was technically known as a broncho-pleural fistula, which is nothing more than an air pipe that doesn’t heal right after surgery. You can imagine that is not a simple problem to deal with. In his instance, the leak was coming directly off one of the air pipes that went to the lobe that was removed, but which did not heal normally.
Is the leaky lung a fairly common experience after lung surgery?
Dr. Eric Sommers: Virtually, everyone will have an air leak after surgery to some degree. For the majority of the patients it is taken care of in the operating room, or resolves in the first 24 to 48 hours. In a small percentage of patients the air leak will persist and take longer to heal.
What is this new Endobronchial Valve do?
Dr. Eric Sommers: The Endobronchial Valve is an ingenious device that is used to create a block to the segment of the lung where the air is leaking. The ingenious part of this technology is that it’s removable. So, it can be placed so that the leak is resolved and the chest tube is removed and the patient can go home and once final healing occurs they can come back and have the valve removed. All done without any additional surgery.
So this looks like an umbrella doesn’t it?
Dr. Eric Sommers: Yes, it does. It looks like a cocktail umbrella. It’s turned upside down so that the concave portion of the umbrella catches the air and prevents the patient from filling that specific part of the lung. This is a very small device and so the amount of lung that is affected is minimized, so it has virtually no effect on the patient’s gas exchange, or the ability of the patient to maintain their oxygen level. It is specific enough in the area of the lung so that the affected part that is leaking is defunctionalized, so that the air no longer has access to the hole and therefore, the hole will heal faster and easier.
So will Mr. Austin’s lung close itself, or is this a permanent fixture?
Dr. Eric Sommers: Mr. Austin has a unique situation. I would anticipate that we would be removing his valve, but it would be a lot longer than what we would do typically after lung surgery. Of course, we will evaluate him on a regular basis and once it is obvious that his fistula is healed permanently then, of course, we will remove the valve.
How do you put this IBV in?
Dr. Eric Sommers: It’s placed using a lighted tube called a bronchoscope. A bronchoscope is nothing more than placing the tube into the patient’s lung through the patient’s mouth and airway and using a very sophisticated set of rules about sizing. We identify the area where the leak is coming from inside and once that is positively identified then we deploy the valve in that specific area. Of course, it is a very specific area of the lung and relatively small area of the total lung capacity.
And then once it is in there it just settles into place?
Dr. Eric Sommers: It has an anchoring system and the anchoring system ensures that it doesn’t move with respiration. Obviously, the lungs go up and down and move back and forth during normal respiration so the anchoring system allows for it to stay in place so the umbrella portion of the device or valve stays where it is intended to be.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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