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Orthodeoxia--an uncommon presentation following bilateral thoracic sympathectomy
P V van Heerden1, P D Cameron, A Karanovic
1Departments of Intensive Care and Vascular Surgery, Sir Charles Gairdner Hospital, Pharmacology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.
Anaesthesia and Intensive Care
|November 7, 2003
Summary
Orthodeoxia, or breathing difficulty when upright, occurred due to lung issues and reduced blood vessel response after bilateral thoracic sympathectomy. This case highlights the impact of sympathetic nerve interruption on pulmonary function.
Area of Science:
- Cardiopulmonary Medicine
- Thoracic Surgery
- Respiratory Physiology
Background:
- Orthodeoxia, characterized by worsening hypoxemia in an upright position, is a rare condition.
- Bilateral thoracic sympathectomy is a surgical procedure that can affect autonomic nervous system control of pulmonary vasculature.
- Hypoxic pulmonary vasoconstriction (HPV) is a critical physiological response that normally maintains ventilation-perfusion matching.
Observation:
- A patient presented with significant orthodeoxia.
- The patient had undergone bilateral thoracic sympathectomy.
- Imaging revealed lung collapse and consolidation.
Findings:
- The orthodeoxia was attributed to a combination of lung collapse/consolidation and impaired hypoxic pulmonary vasoconstriction.
- The blunted HPV response was linked to partial interruption of sympathetic nerve supply to the lung.
- This suggests a novel mechanism for postural hypoxemia following thoracic sympathectomy.
Implications:
- This case underscores the importance of sympathetic innervation in maintaining pulmonary vascular tone and HPV.
- Understanding these mechanisms is crucial for managing patients with complex cardiopulmonary conditions post-thoracic surgery.
- Further research may explore the long-term respiratory consequences of thoracic sympathectomy and potential interventions.
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