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.