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Alain Van Muylem

Publications and source records attributed to Alain Van Muylem.

6 recordsLinked to original sources
PubMed2005

Single-breath test in lateral decubitus reflects function of single lungs grafted for emphysema.

The slope of alveolar plateau for nitrogen derived from the single-breath test is useful to assess the function of bilateral lung grafts, but this technique is not applicable to patients with single-lung grafts due to the confounding influence of the native lung. We tested the hypothesis that the nitrogen slope measured in lateral decubitus with the graft in nondependent position may primarily reflect the distribution of ventilation in this lung. Fifteen patients with single-lung transplantation for emphysema, 10 healthy controls, and 7 patients with advanced emphysema performed single-breath washouts in right and left lateral decubitus; nitrogen slope was measured between 75 and 100% of expired volume. In 10 transplant recipients, the volume of each lung was measured in the two postures by computerized tomography. Nitrogen slope was unaffected by posture in normal controls and emphysema patients. On the other hand, nitrogen slope in transplant recipients was invariably smaller, with the graft in nondependent vs. in dependent position. Values of nitrogen slope with the graft in nondependent position were similar to those obtained in normal controls but significantly smaller than those obtained in emphysema patients. Computerized tomography studies in this position indicated that the volume expired below functional residual capacity was exclusively contributed by the graft. We conclude that, in patients with single-lung transplantation for emphysema, 1) measuring nitrogen slope in lateral decubitus allows to distinguish between the graft and the native lung, and 2) nitrogen slope obtained with the graft in nondependent position reflects ventilation distribution in this lung.

Breath Tests↗
PubMed2005

Monitoring the lung periphery of transplanted lungs.

Lung transplantation is now accepted as a viable therapeutic option for patients with end-stage lung diseases, but long-term survival is threatened by bronchiolitis obliterans (BO), which is regarded as a manifestation of chronic allograft rejection. We have used studies of ventilation distribution for the early detection of this complication. In a prospective study of 57 bilateral-lung transplant recipients, we showed that the slope of phase III of the helium single-breath washout, which targets inhomogeneities of ventilation distribution in the terminal and respiratory bronchioles, was particularly sensitive to the development of BO. In a preliminary study using nitrogen multiple-breath washouts, we showed that S(acin) and S(cond), which reflect structural changes in the acinar and conductive lung zones, were both markedly increased in patients with BO. Taken together, these studies demonstrate that monitoring the function of the allograft by measuring the distribution of ventilation in the lung periphery may be a clinically valuable tool.

Adult↗
PubMed2004

Ventilation asymmetry after transplantation for emphysema: role of chest wall and mediastinum.

After single-lung transplantation for emphysema, the hyperinflated native lung and the graft have different extents and rates of inflation and emptying. This requires that breathing produces asymmetrical expansion of the chest wall, displacement of the mediastinum, or both. In a first study in four seated transplant recipients, we measured the volumes of the two hemithoraces with optoelectronic plethysmography. Functional residual capacity and total lung capacity were identical on the native and transplanted sides, and changes in chest wall volume during CO(2)-induced hyperpnea and FVC maneuvers were similar on both sides. Studies with computerized tomography in three of these patients and in four additional patients in supine posture indicated that the mediastinum was shifted toward the graft at functional residual capacity and total lung capacity. The mediastinum moved toward the native lung during tidal and full inspiration and toward the graft during tidal and forced expiration; additional studies with fluoroscopy showed qualitatively similar changes in upright posture. In summary, the two hemithoraces assume identical static volumes and show similar volume changes during CO(2)-induced hyperpnea and FVC maneuvers in patients with single-lung transplantation for emphysema; displacement of the mediastinum accommodates part, if not all, of the unequal lung volumes and asymmetrical ventilation.

Female↗
PubMed2003

Air trapping in heart-lung transplant recipients: variability of anatomic distribution and extent at sequential expiratory thin-section CT.

PURPOSE: To evaluate the intrapatient reproducibility of the extent and anatomic distribution of air trapping at sequential expiratory thin-section computed tomographic (CT) examinations in heart-lung transplant recipients. MATERIALS AND METHODS: Nineteen heart-lung transplant recipients (eight with and 11 without bronchiolitis obliterans syndrome [BOS]) underwent three expiratory CT examinations within 1 hour. Residual volumes were measured at CT. Anatomic distribution and extent of air trapping were scored by two observers at two independent readings, and the reproducibility of observations was calculated for each feature. CT examination results were compared by using an analysis of variance that took into account interobserver and BOS and non-BOS effects. The Spearman rank correlation coefficient was calculated to test the association between variability of residual volumes and variability of the extent of air trapping. RESULTS: Residual volumes did not significantly differ between the three CT examinations (P =.556). Reproducibility values for findings of anatomic distribution of air trapping ranged from 84% to 95%, with a tendency toward improved reproducibility in patients without BOS. Mean reproducibility values for the extent of air trapping ranged from 97.1% to 97.7%, and no substantial difference in these values between patients with and those without BOS was observed. The Spearman rank coefficient for the correlation between variability of residual volumes and variability of extent of air trapping ranged from 0.382 to 0.568 (P =.105-.016). No interobserver effect was detected (P =.944). CONCLUSION: Anatomic distribution and extent are reproducible characteristics of air trapping. No substantial variability of air trapping occurs in functionally stable heart-lung transplant recipients.

Adult↗
PubMed2002

Modeling of impact of gas molecular diffusion on nitric oxide expired profile.

Present descriptions of nitric oxide (NO) transport in the lungs use two compartment models: airway compartment without mixing and alveolar compartment with perfect mixing. These models neglect NO molecular diffusion in the airways. To assess the impact of axial diffusion on expired NO profile, we solved a transport equation that incorporated diffusion, convection, and NO sources in the symmetrical Weibel model of the lung. When NO parameters computed from experimental data with the two compartment models are used in our model as NO sources, simulated end-expired NO is 29-45 and 64-78% of experimental values at expiratory flows of 50 and 2,000 ml/s, respectively. These lower values are because of NO axial diffusion: During expiration, NO back diffusion (opposed to convection) prevents some NO from being expired, so a two- to fivefold increase of airway NO excretion is necessary to simulate end-expired NO consistent with experimental data. We conclude that, insofar as a significant amount of NO is produced in small airways, models neglecting NO axial diffusion underestimate excretion in the airways.

Computer Simulation↗