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Cardiopulmonary effects following endoscopic thoracic sympathectomy for primary hyperhidrosis

^a Serviço de Cirurgia Cardiotorácica, Hospital de Santa Maria, Lisboa, Portugal
^b Instituto Cardiovascular de Lisboa, Lisboa, Portugal
^c Centro de Cardiologia da Universidade de Lisboa (CCUL), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
^d Dept. Bioestatistica, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
^e Instituto de Fisiologia, Faculdade de Medicina de Lisboa, Lisboa, Portugal
^f Instituto de Medicina Molecular, Lisboa, Portugal
^g Clinica Universitária de Pneumologia de Hospital de Santa Maria, Lisboa, Portugal

Received 3 October 2008; received in revised form 27 March 2009; accepted 31 March 2009.

^_* Corresponding author. Address: Avenida Guerra Junqueiro N°11-4°, Esquerdo 1000-166, Lisbon, Portugal. Tel.: +35 1917389112. (Email: costacruzjorge{at}gmail.com).

Introduction: Endoscopic thoracic sympathectomy (ETS) is performed for the treatment of primary hyperhidrosis (PH). The second and third sympathetic thoracic ganglions excised in ETS also innervate the heart and lung. Objective: In the present work we studied the cardiopulmonary effects of ETS in a group of patients with PH. Methods: We performed a prospective study in 38 patients with severe PH. Pulmonary function, echocardiographic assessment of left ventricular function and myocardial contractility and maximal, symptom-limited, incremental exercise tests were evaluated 2 weeks before, and 6 months after ETS. Data were analysed with the paired t-test. Differences were considered significant when p < 0.05. Results: In pulmonary function tests, we found a statistically significant decrease forced expiratory flow in small airways and an increase of residual volume, a significant decrease in heart rate and ejection fraction, a significant decrease of ‘rest’ and ‘peak’ heart rate, and a significant increase of oxygen pulse (O₂ pulse) and oxygen peak uptake ( peak) after ETS (p < 0.05). Conclusions: These cardiopulmonary effects observed 6 months after ETS in the treatment of patients with PH are all in normal ranges and are not relevant in cardiopulmonary function. We concluded that ETS in patients with PH is a safe procedure. Patients must be informed about these cardiopulmonary effects before the operation.

Key Words: Primary hyperhidrosis • Endoscopic thoracic sympathectomy • Autonomous nervous system • Prospective study