Relation between hemodynamic changes after endoscopic transthoracic sympathicotomy and the number of sympathetic segments operated

Abstract.

We examined the relation between hemodynamic changes after endoscopic transthoracic sympathicotomy (ETS) and the number of sympathetic segment operated. Cardiac functional indices using echocardiography and plasma noradrenaline concentration (NOR) were measured before and after ETS in 25 patients with palmar hyperhidrosis. Patients were divided into 2 groups. Group Th2–3 consisted of 16 patients (mean age 28 ± 8 years),who underwent Th2–3 ETS. Group Th2–4 consisted of 6 patients (mean age 29 ± 9 years), who underwent Th2–4 ETS. Before ETS, all hemodynamic parameters and NOR were similar between the 2 groups. After ETS, heart rate, systolic, diastolic, and mean blood pressures, rate-pressure product, and NOR decreased,whereas left ventricular end-systolic volume index, cardiac index, and ejection fraction did not change in the 2 groups. Systemic vascular resistance decreased in group Th2–4, whereas it did not change in group Th2–3. Left ventricular end-diastolic volume index and stroke index increased in group Th2–3, whereas it did not change in group Th2–4. After ETS, rate-pressure product, systolic, diastolic, and mean blood pressures in group Th2–4 were smaller than those in group Th2–3, whereas other parameters were similar between the 2 groups. Among percent changes in all hemodynamic parameters and NOR occurring after ETS, only the percent decrease in systolic blood pressure in group Th2–4 was larger than that in group Th2–3 (–15 ± 12 % vs.–4±8%, respectively, p < 0.05). These findings suggest that only the change in blood pressure is related to the difference in the number of sympathetic segment operated.