[Endoscopic transthoracic sympathectomy for angina pectoris: a case report]

We performed endoscopic transthoracic sympathicotomy (ETS) for angina pectoris in a 77-year-old female. She had multiple coronary disease of a history of failed percutaneous transluminal coronary angioplasty (PTCA). Bilateral ETS of Th2 to Th5 was carried out under general anesthesia without surgical complication, hemodynamic change and ECG change. Postoperatively she was free from angina and increased working capacity. ST depression on ECG was remarkably improved and the increase of heart rate and systolic blood pressure was suppressed on exercise test after a month of ETS. The effect of ETS to angina pectoris was suspected not to relieve anginal pain but also to reduce myocardial oxygen demand on exercise. We conclude that ETS is a safe, simple and low invasive procedure and it can be done in patients who are judged unsuitable for coronary artery bypass grafting (CABG) or PTCA.