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Research Article Free access | 10.1172/JCI109965

Lung Growth and Airway Function after Lobectomy in Infancy for Congenital Lobar Emphysema

John T. McBride, Mary Ellen B. Wohl, Denise J. Strieder, Andrew C. Jackson, John R. Morton, Robert G. Zwerdling, N. Thorne Griscom, Salvador Treves, Adrian J. Williams, and Samuel Schuster

Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Find articles by McBride, J. in: PubMed | Google Scholar

Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Find articles by Wohl, M. in: PubMed | Google Scholar

Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

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Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

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Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

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Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

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Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Find articles by Griscom, N. in: PubMed | Google Scholar

Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Find articles by Treves, S. in: PubMed | Google Scholar

Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Find articles by Williams, A. in: PubMed | Google Scholar

Department of Pediatrics, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Pathology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

Department of Surgery, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115

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Published November 1, 1980 - More info

Published in Volume 66, Issue 5 on November 1, 1980
J Clin Invest. 1980;66(5):962–970. https://doi.org/10.1172/JCI109965.
© 1980 The American Society for Clinical Investigation
Published November 1, 1980 - Version history
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Abstract

To characterize the outcome of lobectomy in infancy and the low expiratory flows which persist after lobectomy for congenital lobar emphysema, 15 subjects with this history were studied at age 8-30 yr. Total lung capacity was normal in all, but higher values (P < 0.05) were observed in nine subjects with upper lobectomy than in five subjects with right middle lobectomy. Ratio of residual volume to total lung capacity was correlated (P < 0.05) with the amount of lung missing as estimated from normal relative weights of the respective lobes. Xe133 radiospirometry in eight subjects showed that the operated and unoperated sides had nearly equal volumes at total lung capacity, but that the operated side was larger than the unoperated side at residual volume. Perfusion was equally distributed between the two sides. Similar findings were detected radiographically in four other subjects. Forced expiratory volume in 1 s and maximal midexpiratory flow rate averaged 72 and 45% of predicted, respectively. Low values of specific airway conductance and normal density dependence of maximal flows in 12 subjects suggested that obstruction was not limited to peripheral airways. Pathologic observations at the time of surgery and morphometry of the resected lobes were not correlated with any test of pulmonary function.

These data show that lung volume can be completely recovered after lobectomy for congenital lobar emphysema in infancy. The volume increase occurs on the operated side, and probably represents tissue growth rather than simple distension. The response to resection is influenced by the particular lobe resected and may be associated with decreased lung recoil near residual volume. Low expiratory flows in these subjects could be explained by several mechanisms, among which a disproportion between airway and parenchymal growth in infancy (dysanaptic growth) is most compatible with our data.

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