Figure.4: Surgical technique of left cardiac sympathetic denervation by
left posterolateral sympathectomy. Image. A show reflected
posterior parietal pleura with black arrow pointing to left sympathetic
chain. Image. B shows relationship of sympathetic chain with
descending thoracic aorta.
All four children had uneventful postoperative stay in ICU and ward,
except case.3 who developed postoperative TDP. This child was not
reinitiated on beta-blockers immediately after the procedure and hence
predisposed him to develop TDP. Later, he was managed with intravenous
loading dose followed by oral maintenance beta blockers, which prevented
further episodes. Case.1 and Case.4 had immediate reduction in TWA
before discharge from the hospital. All the four children are healthy
and alive without any symptoms till date on latest follow-up.