Technique of Left Cardiac Sympathetic Denervation
(LCSD):
All children were operated under general anesthesia in left lateral
position. Muscle sparing left posterolateral thoracotomy was performed
through 3rd or 4th intercostal space. Pleura was opened and lung was
retracted to expose the posterior mediastinal pleura. Descending
thoracic aorta is identified. A small incision is placed just lateral to
the aorta in the pleura at the level of crossing of 1st superior
intercostal vein. Chain of thoracic sympathetic ganglia are identified
along with stellate ganglion (Fused ganglion of lower cervical and upper
T1 ganglia). Chain is exposed till T4 or T5 (Fig.4). Left cardiac
sympathetic denervation is performed by removing lower half of stellate
ganglion and upper thoracic ganglia (T1-T4/5). Excised nerve tissue is
sent for histopathology for confirmation.
Posterior mediastinal pleura is loosely approximated. One child had
additional PDA which was ligated. Pericardium is opened at the anterior
border and epicardial pacing leads were placed and pulse generator was
positioned in the pleural cavity by suturing it to the thoracic wall.
Thoracotomy is closed in a usual layered manner after placing left
pleural drain. Patients are usually weaned early and extubated within
few hours after shifting to the intensive care unit.