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Endobronchial Valves in the Management of Recurrent Hemoptysis: A Case Report
Válvulas endobronquiales en el manejo de la hemoptisis recurrente, a propósito de un caso
Alan Jhunior Solis Solis
Corresponding author
alanjhuniorsolis@gmail.com

Corresponding author.
, Carmen Angela Centeno Clemente, Antoni Rosell Gratacos
Interventional Pulmonology Department, Hospital University Germans Trias I Pujol, Badalona, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Recurrent hemoptysis in patients with structural lung disease is a common complication that can be life-threatening and difficult to manage&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Endobronchial valves &#40;EBVs&#41; were initially designed for lung volume reduction in severe emphysema&#44; and other indications include the treatment of bronchopleural fistulas and persistent postoperative air leaks&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the use of EBVs in the management of a patient with recurrent threatening hemoptysis despite arterial embolization&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A 29-year-old man with a history of pulmonary tuberculosis in childhood presented with apical cavities in the left upper lobe &#40;LUL&#41; and sequelae including structural damage and loss of volume of the left lung &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In the last 6 months&#44; he was frequently hospitalized for life-threatening hemoptysis&#44; requiring admission to the respiratory semi-critical care unit and bronchial artery embolization &#40;BAE&#41; on up to six occasions&#46; After the last embolization&#44; he had persistent hemoptysis&#44; complicated by acute pulmonary embolism &#40;PE&#41; in the right lower lobe that required placement of an inferior vena cava filter&#46; PE was probably secondary to embolization with Glubran 2&#174; &#40;GEM SRL&#44; Viareggio&#44; Italy&#41;&#46; The indication for urgent surgery &#40;left pneumonectomy&#41; was rejected due to the high surgical risk&#44; and after assessment with interventional pulmonology unit&#44; EBVs were placed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Under sedation and relaxation by anesthesiology&#44; the therapeutic flexible bronchoscope &#40;BF-1TH190&#44; Olympus-Europe&#44; Hamburg&#44; Germany&#41; was introduced via a number 8&#46;5<span class="elsevierStyleHsp" style=""></span>mm orotracheal tube&#46; The presence of fresh clots and remaining bleeding were observed in the left main bronchus coming from both bronchi of the culmen and the lingula&#46; EBVs &#40;Spiration IBV Valve System&#174;&#44; Olympus&#44; Tokyo&#44; Japan&#41; of 6<span class="elsevierStyleHsp" style=""></span>mm and 9<span class="elsevierStyleHsp" style=""></span>mm respectively were placed&#44; with good bronchial occlusion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The patient&#39;s clinical progress was optimal&#44; with no recurrence of hemoptysis&#44; and he was discharged from hospital&#46; For 6 months&#44; he had no episodes of hemoptysis and finally underwent left pneumonectomy after a new episode of hemoptysis&#44; when he was in better condition&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Hospital management of life-threatening hemoptysis includes general measures and protection of the main airway&#46; In the latter case&#44; embolization of the bronchial arteries and&#47;or bronchoscopy procedures may facilitate the therapeutic option&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;6</span></a> This&#44; currently&#44; in cases of persistent hemoptysis with a specific bleeding site&#44; is surgical resection&#44; that may be indicated after considering the greater risk of postoperative complications and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3&#44;6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The objective of endoscopic treatment in the management of hemoptysis is to achieve local tamponade and hemostasis in endoluminal lesions&#44; especially lung cancer&#44; and various treatments such as balloon occlusion&#44; electrocautery&#44; argon plasma coagulation&#44; among others&#44; have been described<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;6</span></a>&#59; however&#44; these methods are of little use in the treatment of hemoptysis caused by tuberculosis or distal structural pulmonary disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In our case&#44; the patient presented recurrent threatening hemoptysis after several embolizations&#44; and the use of EBV was agreed upon prior to the elective surgical option&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Case reports have been reported on the use of EBV in the management of recurrent life-threatening hemoptysis in both benign and malignant pathology&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the case of benign pathology&#44; Frey et al&#46; placed 2 Spiration EBVs in the LUL of a patient with septic pulmonary embolisms due to <span class="elsevierStyleItalic">Staphylococcus</span> bacteremia and recurrent hemoptysis&#44; in whom BAE could not be performed&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Koegelenberg et al&#46; placed 2 Spiration EBVs in the right upper lobe &#40;RUL&#41; and LUL in a patient with hemoptysis and tuberculosis sequelae with aspergilloma&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Lalla et al&#46; reported another case of a Zephyr type EBV placed in the LUL of a man with HIV and active tuberculosis and recurrent hemoptysis&#44; in whom the valve was removed after 6 months with no recurrence of hemoptysis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> All cases were successful&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In malignant pathology&#44; Patel et al&#46; report two cases of Spiration EBV placement&#44; the first in squamous cell carcinoma of RUL&#44; and the second in an esophageal neoplasia with mediastinal invasion that caused hemoptysis from the RUL&#46; Both cases were successful&#44; and there was no recurrence of hemoptysis&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">It has been suggested that the effectiveness of EBV in the management of hemoptysis is due to atelectasis&#44; which in turn promotes local tamponade&#44; favoring clot formation and reducing blood flow to the bleeding area through hypoxic vasoconstriction&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> If the etiology of hemoptysis is benign and&#47;or reversible&#44; the EBV can be removed after treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">There are two types of EBV&#58; Zephyr valves that are used in the management of hemoptysis of infectious etiology<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;4</span></a>&#59; and Spiration valves that are used in the management of hemoptysis of both infectious and malignant etiology&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;3</span></a> In our case&#44; we opted for Spiration valves due to the greater experience of our team&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">This procedure could be an alternative in the management of recurrent hemoptysis in patients who are not candidates for surgery or as a preliminary step toward elective surgery&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0075" class="elsevierStylePara elsevierViewall">Informed consent was obtained from the patient for the publication of his clinical data and the use of diagnostic images&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that no funding was received for this article&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors&#8217; contributions</span><p id="par0085" class="elsevierStylePara elsevierViewall">All the listed authors have made substantial contributions to all areas as outlined therein&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None of the authors has any conflict of interest of any type&#46;</p></span></span>"
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ISSN: 26596636
Original language: English
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