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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Igor E. Konstantinov Mark A.J. Newman Pankaj Saxena Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Konstantinov, I. E. Articles by Saxena, P. Search for Related Content PubMed Articles by Konstantinov, I. E. Articles by Saxena, P. Related Collections Lung - other Related Article

Ann Thorac Surg 2007;84:1075
© 2007 The Society of Thoracic Surgeons

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Correspondence

Reply

Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA 6009 Australia

(Email: igorkonst{at}hotmail.com).

To the Editor:

We thank Dr Srinivasan and colleagues [1] for their interest in our article [2]. It is well known that the first use of intracavitary drainage in the lung was described by Monaldi [3]. In 1949, Drs Jerome Head and Edward Avery [4] modified the Monaldi technique to decompress emphysematous bullae. Clearly we did not "claim to be the first to describe such technique."

The described options for surgical treatment of a giant bullae by two-stage endocavitary aspiration through a thoracotomy with iodine packing to induce pleurodesis (Head-Avery technique) [3, 4], or one-stage endocavitary aspiration with partial rib resection (MacArthur-Fountain technique) [5], or one-stage endocavitary aspiration with talc pleurodesis (Brompton technique) [6] would require either thoracotomy, or rib resection, or chemical induction of pleurodesis. As such, these techniques may not be well tolerated in a setting of acute pneumonia in a ventilated patient with decreased pulmonary reserve as described in our report [2]. Furthermore, pleurodesis would make subsequent thoracoscopic resection of the bulla very difficult if at all possible.

As demonstrated in our report, percutaneous placement of a Foley’s catheter can be an effective temporizing method in a ventilated patient. Pneumothorax can be prevented by simple traction on the catheter allowing ventilatory support to be weaned. The development of local adhesions permits safe removal of the catheter and spontaneous closure of the bronchocutaneous fistula. Acute pneumonia can be treated and pulmonary function optimized prior to resection of the bulla. This technique does not require partial removal of the rib nor chemical pleurodesis and allows subsequent definitive thoracoscopic resection of the bullae in a patient with marginal pulmonary reserve.

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1. Srinivasan B, Biswal S, Singh H, Thingnam SS. Monaldi’s intracavitary decompression and its modifications(letter) Ann Thorac Surg 2007;84:1074-1075.[Free Full Text]
2. Stewart NM, Saxena P, Newman MA, Konstantinov IE. Decompression of giant bulla in acute pneumonia: surgical palliation prior to definitive management Ann Thorac Surg 2006;82:2308-2309.[Abstract/Free Full Text]
3. Monaldi V. Endocavitary aspiration: its practical applications Tubercle 1947;28:223-228.[Medline]
4. Head JR, Avery EE. Intracavitary suction (Monaldi) in the treatment of emphysematous bullae and blebs J Thorac Surg 1949;18:761-776.[Medline]
5. MacArthur AM, Fountain SW. Intracavitary suction and drainage in the treatment of emphysematous bullae Thorax 1977;32:668-672.[Abstract/Free Full Text]
6. Shah SS, Goldstraw P. Surgical treatment of bullous emphysema: experience with the Brompton technique Ann Thorac Surg 1994;58:1452-1456.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Igor E. Konstantinov Mark A.J. Newman Pankaj Saxena Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Konstantinov, I. E. Articles by Saxena, P. Search for Related Content PubMed Articles by Konstantinov, I. E. Articles by Saxena, P. Related Collections Lung - other Related Article