569 Thoracoscopic Sympathectomy for Long-Qt Syndrome In a Sickle Cell Anemia Patient

Background and Aim Long QT syndrome (LQTS) is a relatively common disease, however, it is rarely described in Black African patients. We would like to present a west African patient with sickle cell disease and LQTS who was treated with thoracoscopic left sympathectomy and 1/3 lower stellectomy. Methods An 11-year old boy with sickle cell anemia (Hb=7.2g/dl) was also found to have LQTS. He has had >15 defibrillations in 5 years. He was on high dose beta-blockers but required a number of shocks despite it. Implantable defibrillator was rule out due to his home country lack of cardiac surgical expertise in case of complications. He was considered to be a suitable candidate for sympathectomy. This was done through a 3 trocar approach to the left upper chest. Sympathetic chain including stellate gangion was exposed. 20mls of 0.5% lignoaine was sprayed over the ganglions. Prior to excision of sympathetic chain, all visible nerves traveling medially (to the heart) was excised with hook diathermy. Lower 1/3 of stellate ganglion as well as T2–T4 ganglia was resected en-bloc and submitted for histology. Results There were no per- or post-operative complications and no evidence of Horner’s syndrome post surgery. The patient was discharged 72 hours later. QTc interval before surgery was 532ms and reduced to 448ms prior to discharge. Conclusion Sympathectomy including lower portion of stellate ganglion is a viable alternative for patient with LQTS.