ABSTRACT
The recent reintroduction of lung volume reduction surgery (LVRS) for the treatment of severe emphysema has led to a reevaluation of the pathophysiology of this often debilitating condition. Severe shortness of breath is recognized as the most distressing of the symptoms of the emphysematous form of the chronic obstructive pulmonary disease (COPD) spectrum. The origin of this symptom is likely to be multifactorial, and hence the mechanisms by which LVRS may alleviate symptoms is also likely to be multifactorial. The intimate connection between the function of the respiratory and cardiovascular systems is well established. It is not surprising, therefore, that there should be interest in the effects of LVRS on cardiovascular function and how these effects are integrated into the overall response. Although the cardiovascular effects of COPD have been the subject of hundreds of scientific studies, the majority of these studies do not distinguish between the major subgroups of COPD; namely, chronic bronchitis and emphysema. The effects of the latter are not as well characterized as those of the former. This is in part due to the question of
STEVEN M. SCHARF
IRA L. WEG
CESAR A. KELLER
defining emphysema on clinical, pathological, or physiological grounds. Some of these difficulties also influence the interpretation of studies purporting to assess the hemodynamic effects of emphysema.
