J Korean Pain Soc.  1996 Jun;9(1):235-238.

Heart Failure Occurred during Endoscopic Transthoracic Sympathetic Cauterization: A case report

• Lee YW
• Yoon DM
• Ahn EK
• Seouk MJ

Abstract

Hyperhidrosis is the distressing condition of abnormal sweating which affects the palm, sole and axillary region. Transthoracic endoscopic sympathectomy is recommended as the treatment of choice for hyperhidrosis, especially when the upper limbs are affected. We experienced a case of accidental cauterization of right azygos vein in a healthy 23 year old male during endoscopic transthoracic sympathectomy. We changed the single lumen endotracheal tube to a double lumen tube which made it easier to perform the explo-thoracotomy and bleeder ligation under one lung ventilation. Crystalloid and colloid solutions, and packed RBC were loaded during explo-thoracotomy. Monitoring showed the signs indicating pulmonary edema. Pulmonary arterial catheterization revealed global heart failure. The patient was transfered to ICU for intensive management for heart failure. On the 4th postoperative day, pulmonary edema and heart failure were cured; and the patient was extubated. But in the evening of the same day ST-segment elevation and Q- wave were noted on ECG monitoring. On the 13th postoperative day coronary angiography was performed. This revealed left apex focal hypokinesia, patent coronary artery and accidental right coronay spasm, treated by vasodilator. On the l4 day, after surgery, he was discharged to return to work.

Keyword

Complication; heart failure; Sympathetic nervous system; endoscopic transthoracic sympathectomy; hyperhidrosis

MeSH Terms

Azygos Vein
Catheterization
Catheters
Cautery*
Colloids
Coronary Angiography
Coronary Vessels
Electrocardiography
Heart Failure*
Heart*
Humans
Hyperhidrosis
Hypokinesia
Ligation
Male
One-Lung Ventilation
Pulmonary Edema
Return to Work
Spasm
Sweat
Sweating
Sympathectomy
Sympathetic Nervous System
Upper Extremity
Young Adult
Colloids