Sympathectomy – ABC CARDIOL

IJCS

Case Report

Renal Sympathetic Denervation Using a Novel Device: A Clinical Case Discussion and Literature Update

Esmeralci Ferreira et al. Valerio Fuks Rodolfo Staico Roberto Esporcatte … Andréa Araujo Brandão Denilson Campos Albuquerque

Introduction

Resistant hypertension (RH) is directly related to increased mortality, severe renal changes, and cardiac and cerebrovascular diseases, due to lack of adequate drug treatment. Cardiovascular disease mortality increases progressively and linearly as BP increases, whereas BP lowering is associated with significantly reduced risks.^– Increased sympathetic tone in renal arteries is one of the major components of RH, and catheters have been developed using several technologies which allow for radiofrequency ablation (RA) and blood pressure (BP) reduction. The discussions and controversies about the effectiveness of this treatment are quite broad, especially when associated with the use of new devices. In this clinical case study, with an 18-month follow-up, we describe the development of knowledge regarding this technique and its evidence basis.

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Original Article

Acute Physical Stress Preconditions the Heart Against Ischemia/Reperfusion Injury Through Activation of Sympathetic Nervous System

Alireza Imani et al. Hoda Parsa Leila Gholami Chookalaei Kamran Rakhshan … Masoomeh Golnazari Mahdieh Faghihi

Abstract

Background:

Stress is defined as a complicated state that related to homeostasis disturbances, over-activity of the sympathetic nervous system and hypothalamus-pituitary-adrenal axis responses. Cardiac preconditioning reduces myocardial damages.

Objective:

This study was designed to assess the cardioprotective effects of acute physical stress against ischemia/reperfusion (I/R) injury through the activation of the sympathetic nervous system.

Methods:

Thirty-two male Wistar rats were divided into four groups; (1) IR (n = 8): rats underwent I/R, (2) Acute stress (St+IR) (n = 8): physical stress induced 1-hour before I/R, (3) Sympathectomy (Symp+IR) (n = 8): chemical sympathectomy was done 24-hours before I/R and (4) Sympathectomy- physical stress (Symp+St+IR) (n = 8): chemical sympathectomy induced before physical stress and I/R. Chemical sympathectomy was performed using 6-hydroxydopamine (100 mg/kg, sc). Then, the hearts isolated and located in the Langendorff apparatus to induce 30 minutes ischemia followed by 120 minutes reperfusion. The coronary flows, hemodynamic parameters, infarct size, corticosterone level in serum were investigated. P < 0.05 demonstrated significance.

Results:

Physical stress prior to I/R could improve left ventricular developed pressure (LVDP) and rate product pressure (RPP) of the heart respectively, (63 ± 2 versus 42 ± 1.2, p < 0.05, 70 ± 2 versus 43 ± 2.6, p < 0.05) and reduces infarct size (22.16 ± 1.3 versus 32 ± 1.4, p < 0.05) when compared with the I/R alone. Chemical sympathectomy before physical stress eliminated the protective effect of physical stress on I/R-induced cardiac damages (RPP: 21 ± 6.6 versus 63 ± 2, p < 0.01) (LVDP: 38 ± 4.5 versus 43 ± 2.6, p < 0.01) (infarct size: 35 ± 3.1 versus 22.16 ± 1.3, p < 0.01).

Conclusion:

Findings indicate that acute physical stress can act as a preconditional stimulator and probably, the presence of sympathetic nervous system is necessary.

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Editorial

The Role of Sympathetic System as a Therapeutic Option in the Ischemia/Reperfusion Injury

Bertha F. Polegato et al. Leonardo A. M. Zornoff

Coronary artery disease is the leading cause of mortality and the most resource-consuming health pathology in industrialized countries. In the United States, it is believed that more than 12 million individuals have ischemic heart disease.

It is estimated that approximately 1 million cases of acute coronary syndrome occur annually in the United States, demonstrating that this syndrome occurs in epidemic proportions. Few pathologies have evolved as radically as AMI, with a marked reduction in mortality as a result of changes in treatment over the past 30 years, particularly cardiac reperfusion.^,

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Artigo Original

Endoscopic left sympathetic blockade in the treatment for dilated cardiomyopathy

Paulo M. Pêgo-Fernandes et al. Luiz Felipe P. Moreira Germano Emílio C. Souza Fernando Bacal … Edimar Alcides Bocchi Noedir Antônio G. Stolf Fábio Biscegli Jatene

BACKGROUND: The level of sympathetic nervous activity is a major determinant of prognosis in patients with heart failure. OBJECTIVE: The purpose of this investigation was to perform a proof-of-principle trial of therapeutic endoscopic left thoracic sympathetic blockade in heart failure patients to assess safety and immediate effects. METHODS: Fifteen patients with dilated cardiomyopathy and left ventricular ejection fraction (LVEF) 65 bpm, despite either adequate betablocker use or intolerant to it, were enrolled. Ten patients underwent left infra-stellate ganglion plus T3-T4 interspinal space clipping through videothoracoscopy, while the other five patients were randomized to a control group. RESULTS: None of the treated patients had any procedure-related adverse cardiovascular events at the perioperative period. Two patients from the surgical group died due to pulmonary thromboembolism or myocardial infarction within 6 months of the initial follow-up, while three patients from the control group had heart failure progression and died or developed cardiogenic shock during the same period. Treated patients presented improvement in quality of life, level of physical activity and LVEF (from 25 ± 9% to 32 ± 8%, p=0.024) at 6 months of follow-up, whereas these parameters did not change in control patients. CONCLUSION: Endoscopic left thoracic sympathetic blockade is feasible and appears to be safe in severe heart failure patients. This initial study suggests that this procedure might be an effective alternative approach to sympathetic blockade in the treatment of dilated cardiomyopathies.

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Renal Sympathetic Denervation Using a Novel Device: A Clinical Case Discussion and Literature Update

Introduction

Acute Physical Stress Preconditions the Heart Against Ischemia/Reperfusion Injury Through Activation of Sympathetic Nervous System

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

The Role of Sympathetic System as a Therapeutic Option in the Ischemia/Reperfusion Injury

Endoscopic left sympathetic blockade in the treatment for dilated cardiomyopathy

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