In selected patients with severe heterogenous emphysema lung volume reduction can be performed by using endobronchial valves. So far, only unilateral procedures have been published. Here is described a patient where a right-sided closure of the right upper lobe resulted in an increase of FEV1sec of more than 50%, and some years later the procedure was repeated on the left side with further considerable improvement. A tracheal bronchus to the apical segment of the right upper lobe made measuring the collateral flow at bronchoscopy impossible, but clearly visible fissures were used as a substitute. In conclusion, valve treatment in suitable patients can give substantial improvement in lung function and quality of life and can be repeated on the other side if warranted some years later.
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