Effect of Endoscopic Transthoracic Sympathicotomy on Plasma Natriuretic Peptide Concentrations in Humans

Abstract

ndoscopic transthoracic sympathicotomy (ETS) is a safe and effective procedure that is used for the treatment of palmar hyperhidrosis. 1,2 The upper third or fourth thoracic, stellate, and cervical sympathetic ganglia receive the preganglionic fibers from the upper 4 thoracic segments of the spinal cord and direct the postganglionic fibers to the heart, upper extremities and cranial vessels. 3 Therefore, ETS results in blockade of efferent sympathetic nerves that innervate the heart and upper extremities.Natriuretic peptides are secreted into the systemic circulation in response to numerous factors, including increased atrial and/or ventricular wall tension, tachycardia, exercise, endothelin, arginine vasopressin and catecholamines. 4 An interaction between the sympathetic nervous system and the natriuretic peptide system has been suggested by experimental studies that demonstrated suppression of cardiac atrial natriuretic peptide (ANP) release in response to -adrenergic stimulation. 5,6 This is corroborated by other studies that demonstrated augmentation of cardiac natriuretic peptides by pharmacological -receptor blockade in humans. [7][8][9] However, the precise effect of the sympathetic nervous system on the natriuretic peptide system remains unclear.Therefore, we examined the effect of ETS of the second Circulation Journal Vol.69, September 2005and third thoracic sympathetic ganglia (Th2-3) on cardiac function and plasma ANP and brain natriuretic peptide (BNP) concentrations in patients with primary palmar hyperhidrosis to characterize the role of the sympathetic nervous system in the regulation of plasma natriuretic peptides. Methods Patient SelectionThirty-seven patients (19 males, 18 females, mean age 29±10 years; mean ± SD) underwent ETS for treatment of primary palmar hyperhidrosis. None had a history of cardiac disease nor were they receiving any drugs that could directly or indirectly modulate the autonomic nervous system. Written informed consent was obtained from all patients before enrollment. Study protocols were approved by the institutional committee on human research. ETSThe operative technique, which has previously been described in detail, 8,10 has been used in more than 600 patients with palmar hyperhidrosis at the Kanazawa Medical Center since 1993. Briefly, patients were intubated with an endotracheal tube under general anesthesia and placed in a semireclining position with both arms in abduction. The pleural cavity was accessed via a Surgineedle in the axillary fossa, and approximately 2 L of carbon dioxide was insufflated into the pleural cavity. A modified urological electroresectoscope was introduced via the same incision in the axillary fossa to visualize the upper thoracic cavity. The sympathetic chain was identified in the immediate vicinity of the cost- Effect of Endoscopic Transthoracic Sympathicotomy on Plasma Natriuretic Peptide Concentrations in HumansYukio Nakamura, MD; Hisashi Yoshizawa, MD; Motoaki Hirasawa, MD;Hiroshi Kida, MD; Yasushi Matsumoto, MD*; Takeshi Ueyama, MD* ...

Surgical Thoracic Sympathectomy Induces Structural and Biomechanical Remodeling of the Thoracic Aorta in a Porcine Model

“…First, sympathectomy leads to lower arterial pressure due to diminished peripheral vasomotor activity. This has been documented after thoracic sympathectomy in the clinical setting [16][17][18]. A decreased pressure load would not eventuate in increased aortic wall thickness and extracellular matrix contents as observed in this study, those being well known features of hypertensive hemodynamic remodeling [19,20].…”

“…As this had not been demonstrated before, in the case of a negative study after limited resection, we would be unable to discern whether the negative outcome was associated with the extent of the procedure or merely resulted from the fact that surgical thoracic sympathectomy had no effect on the aortic wall whatsoever. On the other hand, clinical thoracic sympathectomy, while limited, is sufficient to generate a variety of measurable long-term cardiovascular sequelae, reportedly including decreased heart rate, arterial pressure, and systemic vascular resistance, and increased left ventricular end-diastolic volume, stroke index, and ejection fraction [16][17][18]. In this regard, additional experimental and clinical studies defining the long-term effects of limited thoracic sympathectomy on aortic structure and biomechanics are warranted.…”

An obesity drug sibutramine reduces brain natriuretic peptide (BNP) levels in severely obese patients

“…examined the effect of endoscopic transthoracic sympathicotomy (ETS) of the second and third thoracic sympathetic ganglia on cardiac function and plasma ANP and BNP concentrations in patients with primary palmar hyperhidrosis to characterise the role of the sympathetic nervous system in the regulation of plasma natriuretic peptides. The plasma concentrations of ANP and BNP increased after ETS, independent of hemodynamic changes, and apparently because of the release of the inhibitory effects of the cardiac sympathetic nerves on natriuretic peptide secretion (20). Peripheral sympathetic stimulation because of sibutramine may decrease plasma concentration of BNP.…”

Endoscopic thoracic sympathectomy as a novel strategy for vasospastic angina refractory to medical treatments

“…A previous report showed that ETS had a long-term effect on cardiac autonomic tone [7]. ETS is a therapeutic tool for palmer hyperhidrosis, reflex sympathetic dystrophy, circulatory disturbances of the upper extremities, and refractory angina in the presence of organic coronary stenosis [3,4,8,9]. To our knowledge, this is the first report describing the application of ETS for refractory VSA.…”

“…ETS was performed in all 5 patients based upon a previously described technique [3,4]. Briefly, patients were intubated with an endotracheal tube under general anesthesia and placed in a semireclining position with both arms in abduction.…”