STUDIES OF REGIONAL VENTILATION AND PERFUSION IN PULMONARY EMPHYSEMA USING XENON133

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Abstract
Forty patients suffering from pulmonary emphysema have been studied by the use of xenon133. This technique permitted an appraisal in each patient of impairment of ventilation and perfusion in six lung zones. By the technique the patients could be divided into the following five groups: Group 1: unilateral impairment (3 cases); Group 2: bilateral: predominantly upper zone defect (3 cases); Group 3: bilateral: predominantly lower zone defect (20 cases); Group 4: diffuse defect with zonal predominance (9 cases); Group 5: diffuse defect with no zonal predominance (5 cases). Excepting the patients in Group 1, routine tests of pulmonary function did not permit differ- entiation between the groups. The zonal distribution of perfusion impairment as found by the xenon133 technique agreed with the reduction in pulmonary vasculature reported from tomograms in 25 of the 32 patients of whom the films were made. In 9 patients studied by pulmonary angiograms, there was agreement on the zone of major impairment in all cases. In the large majority of the patients studied, regional impairment of ventilation was accompanied by impairment of perfusion to the same zone. A meaningful distribution of V/Q ratios cannot be calculated from the present data, and a more complex analysis will be required before this result can be achieved. In 7 patients lobectomies were performed to remove areas of major functional involvement as defined with xenon133. In all of these patients these zones were found to be destroyed by emphysema. The present findings of zonal predominance of disease in 35 of the 40 patients studied suggest that the concept of emphysema as a generalized process in the majority of patients may well be incorrect. The precise quantitation of regional function in this disease is a prerequisite to an intelligent surgical approach to its treatment.