Endoscopic transthoracic sympathicotomy for severe angina

Wettervik, Christer; Tygesen, Hans; G, Claes; Drott, Christer; Emanuelsson, Håkan; Lomsky, Milan; Rådberg, Göran

doi:10.1016/s0140-6736(95)90065-9

Cited by 62 publications

(36 citation statements)

References 6 publications

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“…The drawback of these destructive experimental treatments is a relatively high mortality and morbidity, ranging from 5-10%. 18 Arbitrarily, these latter adjunctive treatments could also be classified into the next category.…”

Section: Treatment For Anginamentioning

confidence: 99%

Chronic therapeutically refractory angina pectoris

DeJongste

2004

Heart

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Section: Treatment For Anginamentioning

confidence: 99%

Chronic therapeutically refractory angina pectoris

DeJongste

2004

Heart

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“…3,4 Endoscopic transthoracic sympathicotomy acts much like a selective cardiac -receptor blockade. Observations from the present study, which showed that ETS reduces the ratepressure product during exercise without causing a significant fall in cardiac function in terms of stroke volume and that the effect of ETS on blunted heart rate responses to exercise persists for at least 1 year, support the benefits and safety of ETS for the treatment of selected patients with severe angina pectoris as well as for patients with palmar hyperhidrosis.…”

Section: Fig 2 Effects Of Endoscopic Transthoracic Sympathicotomy (Ets)mentioning

confidence: 99%

“…1,2 Because of its minimal morbidity and mortality, renewed interest has been expressed in ETS as a palliative approach to patients with severe angina pectoris, who are not suitable for coronary artery bypass grafting or angioplasty. 3,4 Anatomically, 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 targets, including the heart, the upper extremities, and the cranial vessels. 5 Endoscopic transthoracic sympathicotomy blocks efferent sympathetic nerves to the heart as well as the upper extremities; however, the effect of ETS on the cardiovascular system remains unclear.…”

mentioning

confidence: 99%

Effects of Endoscopic Transthoracic Sympathicotomy on Hemodynamic and Neurohumoral Responses to Exercise in Humans.

Nakamura

Fujimoto

Nagata

et al. 2002

Circ J

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ndoscopic transthoracic sympathicotomy (ETS) is a recently developed technique to divide sympathetic nerves and has been used successfully in the treatment of palmar hyperhidrosis, causalgia, or ischemia of the upper extremities. 1,2 Because of its minimal morbidity and mortality, renewed interest has been expressed in ETS as a palliative approach to patients with severe angina pectoris, who are not suitable for coronary artery bypass grafting or angioplasty. 3,4 Anatomically, 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 targets, including the heart, the upper extremities, and the cranial vessels. 5 Endoscopic transthoracic sympathicotomy blocks efferent sympathetic nerves to the heart as well as the upper extremities; however, the effect of ETS on the cardiovascular system remains unclear. The purpose of the present study was to examine the effect of Th 2-3 ETS on hemodynamic and neurohumoral responses to exercise in patients with palmar hyperhidrosis. Methods Patient SelectionTwenty-one patients with primary palmar hyperhidrosis Circulation Journal Vol.66, April 2002(10 males and 11 females, mean age 28±3 years; mean ± SEM) participated in the study. None of these patients had cardiac disease nor were receiving any drug that might affect autonomic function directly or indirectly. All patients gave their informed consent before participating. Endoscopic Transthoracic SympathicotomyThe operative technique, which has been described in detail elsewhere, 2,6 has been used in more than 400 patients with palmar hyperhidrosis at National Kanazawa Hospital since 1993. Patients were intubated with an endotracheal tube under general anesthesia and placed in a semireclining position with both arms in abduction. (In the semireclining position, the pneumothorax is located in the apical region.) Approximately 2 liters of carbon dioxide was insufflated into the pleural cavity through a Surgineedle entered via the axillary fossa. A modified urological electroresectoscope was introduced via the same incision into the axillary fossa, thus obtaining an excellent view of the upper thoracic cavity. The sympathetic chain can be identified lying over or in the immediate vicinity of the costovertebral joint. The second and third thoracic sympathetic ganglia, including rami communicantes, were destroyed by electrocautery. After exsufflation of the gas, the procedure was repeated on the opposite side. Operation time was within 30 min. The patient was discharged from hospital the day after operation and the hospital stay was 2 days. Most patients resumed work within a few days and resumed sports activities within 2 weeks. Treadmill Exercise TestSubmaximal, graded, upright treadmill exercise was performed according to a modified Bruce protocol comprising Circ J 2002; 66: 357 -361 (Received July 25, 2001; revised manuscript received December 11, 2001; accepted January 10, 20...

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“…18 Hyperhidrosis remains the main indication for sympathectomy, but the procedure is also used in the treatment of vasospastic syndromes, 22 angina pectoris, 41 and certain cardiac arrythmias (long QT syndrome 31 ), as well as in severe forms of facial blushing 40,42,43 and causalgia. 29 The surgical methods have varied over the years, 1,35,36 but after the introduction of thoracoscopic surgery, thoracoscopic sympathectomy or sympathicotomy (i.e., transection of the sympathetic chain) has become the standard procedure.…”

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confidence: 99%