Abstract P064: Case Report of Mals Surgery in Postural Orthostatic Tachycardia Syndrome

Abstract

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia associated with variety of symptoms like Headache, Abdominal discomfort, Dizziness/presyncope, Nausea, Fatigue, Lightheadedness, Sweating Sleep disorder, Tremor, Anxiety, Palpitations, Exercise intolerance. Median arcuate ligament syndrome (MALS, also known as celiac artery compression syndrome) is a condition characterized by abdominal pain, delayed gastric emptying, nausea, weight loss and other symptoms of autonomic dysfunction attributed to compression of the celiac artery and possibly the celiac ganglia by the median arcuate ligament. The researchers suggest that MALS should be considered in POTS patients who have persistent gastrointestinal symptoms. The purpose of this research is to study the celiac artery velocity in POTS patients. That led us to think about an operative procedure that can reduce POTS symptoms through MALS surgery. Patients and Method: We present the case of a 17 year old male with POTS symptoms not improving with medical management and celiac artery ultrasound positive for MALS.His celiac artery velocities was higher in Inspiration as well as Expiration and MALS is confirmed with CT angiogram.He underwent laparoscopic MALS surgery where the Median arcuate ligament is flipped thereby decreasing the extrinsic compression on the celiac artery. Results: There appears to be tremendous improvement in the patient’s symptoms after the surgery for MALS.His nausea had almost disappeared.Before surgery he had vomiting twice a week, after surgery he had vomiting four times in three months. His lightheadedness had disappeared. Bluish discoloration of arms and feet when he used to stand had disappeared in the hospital after the procedure. Sensations of hands had improved. Heat intolerance had improved. His Sleep and constipation improved. There was no much improvement in fatigue. Autonomic tilt table test is repeated after surgery to see if there is definite objective change, Heart rate in the first 10 minutes of tilt test before the surgery was >120bpm,Heart rate after the surgery was <100 bpm. Conclusions: Laparoscopic MALS surgery was found to be extremely helpful in relieving POTS symptoms with immediate results.