title: Left thoracoscopic sympathectomy used as primary therapy for a young child with intractable long QT syndrome.
abstract: A 3-year-old boy with familial long QT syndrome type 2 presented with recurrent syncope despite adequate beta-blocker therapy. Two family members had experienced sudden cardiac arrest, and one other relative had experienced sudden cardiac death. Given the high risk for ventricular arrhythmia/syncope, the decision was made to perform primary cardiac denervation therapy through a minimally invasive approach without concomitant automatic cardioverter-defibrillator implantation. Using video-assisted thoracoscopic surgery, the left-sided sympathetic ganglia from T2-T5 were identified, and dissection along the sympathetic chain with transection of the corresponding rami along T2-T5 in addition to the lower half of the stellate ganglion was performed. The chest tube was removed on day 1 after surgery, and the patient was discharged on postoperative day 4. During 14 months of follow-up evaluation, no intervening episodes of ventricular arrhythmia or syncope and no symptoms of Horner's syndrome were noted.
authors.affiliation: Division of Cardiovascular Surgery, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA.
authors.forename: Dingchao
authors.initials: D
authors.lastname: He
authors.forename: John P
authors.initials: JP
authors.lastname: Costello
authors.forename: Evan P
authors.initials: EP
authors.lastname: Nadler
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Moak
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
mesh_terms: D002675:Child, Preschool; D006339:Heart Rate; D006801:Humans; D008133:Long QT Syndrome / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D013233:Stellate Ganglion / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted