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Eur J Cardiothorac Surg 2001;20:25-29
© 2001 Elsevier Science NL

Role of physiological lung exclusion in difficult lung resections for massive hemoptysis and other problems

^a Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
^b Department of CTV Surgery, Government Medical College, Amritsar, India

Received 9 October 2000; received in revised form 14 February 2001; accepted 14 March 2001.

Corresponding author. CTV Surgery, P.O. Box 1515, PGI Campus, Chandigarh 160012, India. Tel.: +91-172-711070; fax: +91-172-744401
e-mail: rsdhaliwal{at}glide.net.in

Objectives: Pulmonary tuberculosis and bronchiectasis are the major causes of massive hemoptysis in developing countries. Lung resection remains the surgical treatment of choice. This may not always be possible and may even be hazardous in some patients due to fibrosis and dense vascular adhesions between the lung and the chest wall. This leads to marked blood loss and control of hilar vessels becomes dangerous. Methods: A series of 20 cases is described here. Nineteen presented with massive hemoptysis where control of bleeding was obtained by physiological lung exclusion. One patient had traumatic left main bronchus transection not suitable for repair or resection. Physiological lung exclusion was performed by surgical interruption of the bronchus and pulmonary artery of the involved lobe or lung, keeping pulmonary veins intact. Results: Hemoptysis could be controlled in all these patients without any significant morbidity. There was no mortality. There was no postoperative empyema and recurrence of hemoptysis on long-term follow-up. No patient required anatomical lung resection later on. Conclusions: Physiological lung exclusion is a safe and effective method for control of massive hemoptysis in cases where lung resection is technically hazardous or difficult. This should be kept as an alternative or adjunct to anatomical lung resection.

Key Words: Massive hemoptysis • Lung resection • Physiological lung exclusion

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