Vocal Cord Palsy Following Surgery for Congenital Heart Disease: The Elephant in the Room

Abstract

Objective: We retrospectively evaluated the natural history of vocal cord palsy (VCP) in children at risk of injury to the recurrent laryngeal nerves (RLN) during surgery for congenital heart disease (CHD). Methods: From 2013 to 2017, 308 patients underwent operations at risk of causing VCP including hypoplastic aortic arch (n=74), interrupted aortic arch (n=3), Norwood procedure (n=37), coarctation of aorta (n=71), truncus arteriosus/IAA (n=9), arterial switch (n=63), and patent ductus arteriosus closure (n=51). Diagnosis of VCP was confirmed with flexible nasoendoscopy. Results: VCP was confirmed in 50 (16%) patients. VCP was highest following hypoplastic arch repair (26/74, 35%) and Norwood procedure (10/37, 27%). Main symptoms included inspiratory stridor (n=18, 36%) and hoarse/weak cry (n=31, 62%). Three (6%) patients had aspiration and 20 (40%) developed pneumonia. Nasogastric tube feeding was required in 47 (94%) patients for a median duration of 15.5 days (9-118 days). No patient received a gastrostomy. Thirty-three (65%) patients were followed up in ENT outpatients post-discharge for a median duration of 414 days (120-630 days). Median duration for recovery of VCP was 82 days (30-420 days). Of the remaining 258 (84%) patients at risk of VCP, none received a documented speech pathology assessment or flexible nasoendoscopy. Sixty-seven (26%) had pneumonia, aspiration or required nasogastric feeding. Conclusions: In patients at risk of VCP following surgery for CHD, the incidence of VCP is underestimated and current diagnosis is suboptimal. VCP recovers but requires follow up and prolonged nasogastric tube feeding. A structured multidisciplinary approach is warranted for the management of patients at risk of VCP.L20122710872021-08-02 <br />