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.