title: Posterior left thoracic cardiac sympathectomy by surgical division of the sympathetic chain: an alternative approach to treatment of the long QT syndrome.
abstract: Although high thoracic left sympathectomy via an anterior surgical approach is a highly efficacious treatment for refractory ventricular arrhythmias in patients with the long QT syndrome, the degree of sympathetic denervation has been variable, success of the operation is influenced by anatomical differences between patients, and Horner's syndrome may result. We hypothesized that interruption of sympathetic input to the heart could be accomplished using a posterior thoracic approach to this variable and often complex anatomy by division of the sympathetic chain rather than by direct destruction of the stellate and superior thoracic ganglia with the more conventional anterior, supraclavicular approach. In addition, the posterior approach should decrease the risk of Horner's syndrome by avoiding the ocular sympathetic efferent nerves. This posterior approach is described in five patients with the long QT syndrome and recurrent ventricular arrhythmias. After a mean follow-up of 18 +/- 12 months, all are alive without Horner's syndrome.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham 35294, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Epstein
authors.forename: M J
authors.initials: MJ
authors.lastname: Rosner
authors.forename: G R
authors.initials: GR
authors.lastname: Hageman
authors.forename: J H
authors.initials: JH
authors.lastname: Baker
authors.forename: V J
authors.initials: VJ
authors.lastname: Plumb
authors.forename: G N
authors.initials: GN
authors.lastname: Kay
mesh_terms: D000328:Adult; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D015171:Ganglionectomy / Q000379:methods*; D006321:Heart / Q000294:innervation; D006732:Horner Syndrome / Q000517:prevention & control; D006801:Humans; D007430:Intraoperative Care; D008133:Long QT Syndrome / Q000601:surgery*; D013233:Stellate Ganglion / Q000601:surgery; D013997:Time Factors