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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims Prinzmetal angina is a know condition of intermittent segmental spasm in the coronary arteries causing transient ischemia resulting in angina and electrocardiographic ST elevation. Medical treatment includes both calcium channel blockers and nitrites. We present a case of a 49-year-old male with a 30-year history of Prinzmetal angina with failed medical management for possible thoracoscopic surgical cardiac sympathetic denervation. The patient was referred for a trial stellate ganglion block to temporarily inhibit the cardiac sympathetic chain.
Methods A left stellate ganglion catheter was placed at anterior C 6 tubercle under ultrasound and fluoroscopic guidance. Contrast was injected into the catheter to confirm appropriate spread of contrast in the region of the stellate ganglion. (Figure 1) A pulsed dose of 5 cc every 2 hours of 0.2% ropivacaine was infused for 3 days. The patient had significant reduction of pain and incidence of his symptoms and elected for surgery. The patient underwent bilateral thoracoscopic sympathectomy for permanent treatment of his Prinzmetal angina. Of interest 5 cc of methylene blue dye was injected into the left sided catheter immediately prior to surgery and was seen in the right, and not the left chest. Figure 2
Results The patient had significant reduction of the severity and incidence of his Prinzmetal angina. He has decreased his dose of nitrites and calcium channel blockers and is normotensive. Stellate ganglion catheters provide an extended trial of cardiac sympathectomy and may be helpful in predicting success of surgery.
Contrast Stellate Ganglion
Methylene Blue Dye Right Chest