Pediatric Cardiology

, Volume 34, Issue 8, pp 1969–1971 | Cite as

Left Thoracoscopic Sympathectomy Used as Primary Therapy for a Young Child With Intractable Long QT Syndrome

  • Dingchao He
  • John P. Costello
  • Evan P. Nadler
  • Jeffrey P. Moak
  • Richard A. Jonas
  • Dilip S. NathEmail author
Case Report


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.


Left cardiac sympathetic denervation Long QT syndrome Video-assisted thoracoscopic surgery 

Supplementary material

Supplementary material 1 (WMV 145361 kb)


  1. 1.
    Atallah J, Fynn-Thompson F, Cecchin F, DiBardino DJ, Walsh EP, Berul CI (2008) Video-assisted thoracoscopic cardiac denervation: a potential novel therapeutic option for children with intractable ventricular arrhythmias. Ann Thorac Surg 86:1620–1625CrossRefPubMedGoogle Scholar
  2. 2.
    Chen L, Qin YW, Zheng CZ (1997) Left cervicothoracic sympathetic ganglionectomy with thoracoscope for the treatment of idiopathic long QT syndrome. Int J Cardiol 61:1–3CrossRefPubMedGoogle Scholar
  3. 3.
    Collura CA, Johnson JN, Moir C, Ackerman MJ (2009) Left cardiac sympathetic denervation for the treatment of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia using video-assisted thoracic surgery. Heart Rhythm 6:752–759CrossRefPubMedGoogle Scholar
  4. 4.
    Crotti L, Celano G, Dagradi F, Schwartz PJ (2008) Congenital long QT syndrome (review). Orphanet J Rare Dis 3:18PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Hwang SW, Thomas JG, Whitehead WE, Curry DJ, Dauser RC, Kim ES, Luerss TG, Jea A (2011) Left thorascopic sympathectomy for refractory long QT syndrome in children. J Neurosurg Pediatr 8:455–459CrossRefPubMedGoogle Scholar
  6. 6.
    Li J, Liu Y, Yang F, Jiang G, Li C, Hu D, Wang J (2008) Video-assisted thoracoscopic left cardiac sympathetic denervation: a reliable minimally invasive approach for congenital long QT syndrome. Ann Thorac Surg 86:1955–1958CrossRefPubMedGoogle Scholar
  7. 7.
    Reardon PR, Matthews BD, Scarborough TK, Preciado A, Marti JL, Conklin LD, Garson A, Reardon MJ (2000) Left thoracoscopic sympathectomy and stellate ganglionectomy for treatment of the long QT syndrome. Surg Endosc 14:86–87CrossRefPubMedGoogle Scholar
  8. 8.
    Schwartz PJ, Priori SG, Cerrone M, Spazzolini C, Odero A, Napolitano C, Bloise R, Ferrari GM, Klersy C, Moss AJ, Zareba W, Robinson JL, Hall WJ, Brink PA, Toivonen L, Epstein AE, Li C, Hu D (2004) Left cardiac sympathetic denervation in the management of high-risk patients affected by the long QT syndrome. Circulation 109:1826–1833CrossRefPubMedGoogle Scholar
  9. 9.
    Silver ES, Liberman L, Chung WK, Spotnitz HM, Chen JM, Ackerman MJ, Moir C, Hordof AJ, Pass RH (2009) Long QT syndrome due to a novel mutation in SCN5A: treatment with ICD placement at 1 month and left cardiac sympathetic denervation at 3 months of age. J Interv Card Electrophysiol 26:41–45Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Dingchao He
    • 1
  • John P. Costello
    • 1
  • Evan P. Nadler
    • 2
  • Jeffrey P. Moak
    • 3
  • Richard A. Jonas
    • 1
  • Dilip S. Nath
    • 1
    Email author
  1. 1.Division of Cardiovascular SurgeryChildren’s National Medical CenterWashingtonUSA
  2. 2.Division of Pediatric SurgeryChildren’s National Medical CenterWashingtonUSA
  3. 3.Division of CardiologyChildren’s National Medical CenterWashingtonUSA

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