Procedure:
The patient was brought to the operating room to undergo bilateral VATS
procedure. After insertion of a camera port and 2 additional working
ports in the right chest, the right sided sympathetic trunk and stellate
ganglia were identified. The sympathetic trunk along with the inferior
portion of the stellate ganglia were mobilized at the level of T1-T4 and
were then divided using electrocautery. A lateral extension was done to
dissect the nerves of Kuntz. The surgical procedure was then repeated on
the left side. Bilateral chest tubes were placed. The patient tolerated
the procedure well.
Following the procedure, the patient did not experience any episodes of
VT and she subsequently remained in sinus rhythm. A postoperative echo
demonstrated improved ejection fraction of 40% and the patient was
decannulated from ECMO 3 days after the operation. The patient continued
to improve and was weaning off her blood pressure support. She remained
in sinus rhythm and on anticoagulation due to right lower extremity DVT.
Unfortunately, the patient experienced sudden onset hemorrhagic shock
from a spontaneous liver laceration several weeks after the operation
and expired.