Lungs

Breathing Easier After Innovative Hyperinflation Procedure

Private: Majid Shafiq, MD, MPH
Contributor Majid Shafiq, MD, MPH
Private: Margaret Blair Marshall, MD
Contributor Margaret Blair Marshall, MD

Carol Santilli, 69, began having breathing problems about 15 years ago. The short walk from her car to the shuttle bringing her to her job at a Boston hospital left her winded. Eventually, even showering became a herculean task.

An upper respiratory infection about 6 years ago finally spurred her to quit smoking, but emphysema continued to make breathing difficult. Then one day, her sister saw an advertisement for a new treatment for hyperinflation, the lung condition that contributed to her breathing problems. Hyperinflation occurs when air gets trapped in diseased parts of the lungs, causing them to overinflate. Like a balloon that has been blown up too much, the lungs have trouble taking in air because there just isn’t room. Hyperinflation often occurs in people with emphysema.

Minimally invasive lung valve insertion procedure

The treatment Santilli’s sister heard about is a lung valve insertion procedure that involves putting tiny valves into the lungs to isolate and collapse unhealthy areas. This enables the patient to take in more air and breathe normally. It’s the less invasive equivalent of a surgical technique called lung volume reduction surgery, where the surgeon cuts out the diseased portion of the lung. That operation can have a longer recovery time than valve placement. In early 2020, Santilli began to investigate the new procedure and learned that Brigham and Women’s Hospital was one of the few places that offered it.

Emphysema afflicts millions of Americans every year, and Brigham and Women’s Hospital has become a leader in its treatment. A multidisciplinary team of experts uses a robust evaluation process to determine the best way forward for patients, sometimes valve insertion and other times lung volume reduction surgery. “In some cases, a lung transplant may be the best choice,” explained Majid Shafiq, MD, MPH, an interventional pulmonologist who treated Santilli.

At her initial consultation with Dr. Shafiq, he took a thorough medical history and ran a battery of breathing tests. He concluded Santilli was a good candidate for the lung valve insertion. Then he said something that clinched the deal for her. “He told me he would take care of me as if I were his mother,” recounted Santilli. “He put me at ease.”

“My doctors were all wonderful, the nurses were excellent and the anesthesiologists were fabulous. Everyone is very professional and treats you with dignity, respect and compassion.”

Carol Santilli, lung patient

Bilateral lung valve placement

In October 2020, Dr. Shafiq inserted a valve into Santilli’s left lung through thin tubing introduced through her mouth. This procedure requires no incisions (surgical cuts). As is often the case, both Santilli’s lungs were hyperinflated, but clinical studies have almost solely focused on reducing hyperinflation in a single lung. The procedure went well and it reduced her hyperinflation.

Although CT scans showed that the procedure was technically successful and Santilli felt a little better, months later she continued to struggle with breathing. So she and Dr. Shafiq began talking about doing the same procedure on her right lung. He ran tests to determine if she would be a suitable candidate. At that time, valve placement in a patient’s second lung had been done only when the first lung procedure had been unsuccessful.

“But our thinking was that if one lung can benefit from the procedure, why not the other lung, too?” explained Dr. Shafiq.

Fissure and valve procedures reduce hyperinflation in right lung

But there was a problem. Imaging revealed that Santilli’s right lung had incomplete fissures — the boundaries that divide the lung into three different areas called lobes. The incomplete fissures allow air “to take a back door route” into the part of the lung that needs to be isolated and collapsed, explained thoracic surgeon Margaret Blair Marshall, MD.

Yet there was a surgical solution. Eight months after Santilli’s first valve insertion, Dr. Marshall successfully operated on Santilli to complete her fissures. In a back-to-back procedure, Dr. Shafiq then implanted a valve in her second lung. The two procedures took less than 3 hours total, leaving Santilli with a trio of small incisions. She was up and walking the next day and spent an additional 2 days in the hospital recovering. The fissure operation didn’t prolong her stay. After discharge, a visiting nurse came a couple of times to check on Santilli at home. Within a month, Santilli was feeling very well.

Thriving and traveling after lung valve treatment

The procedure has transformed Santilli’s quality of life. “I went to a friend’s house in New Hampshire and was able to walk from her cottage to the lake, something I had not been able to do the previous year,” said Santilli. She is now able to ascend the two flights of stairs to her sister’s house, an impossibility before the procedure. Following her second procedure, she also traveled to Italy with her husband, Michael Shearns.

Carol Santilli and her husband, Michael Shearns, visit Rome following her second lung valve procedure.

Michael no longer has to drop her off in front of restaurants before he looks for parking. “And I don’t have to organize things around my breathing issues,” she added. “I used to hate the stairs in my house and I no longer care if I’ve forgotten something upstairs or downstairs.”

Friends often comment about how much healthier she looks. “My skin color has gone from a grayish hue to a warmer color,” she said. Dr. Shafiq said the results of Santilli’s pulmonary function tests confirm that her hyperinflation has gone from extreme to mild. These tests measure things like how much air her lungs can hold and how forcefully she can expel air.

Santilli was impressed with the entire Brigham and Women’s care team: “My doctors were all wonderful, the nurses were excellent and the anesthesiologists were fabulous. Everyone is very professional and treats you with dignity, respect and compassion.”

As for the future of bilateral valve placement, Dr. Shafiq believes the procedure will become more common in the future. He has been sharing lessons learned treating Santilli and other patients with complex cases with the medical community so that more patients can benefit from the Brigham Lung Center experience.


Private: Majid Shafiq, MD, MPH
Majid Shafiq, MD, MPH

Dr. Shafiq is medical director of interventional pulmonology at Brigham and Women's hospital.

Private: Margaret Blair Marshall, MD
Margaret Blair Marshall, MD

Dr. Marshall is a thoracic surgeon at Brigham and Women's Hospital.

Before you go,

Learn about managing lung conditions, from asthma to COPD and lung cancer, and what treatment options can help you optimize your health. Read more articles about lung conditions.