Vocal cord dysfunction and feeding difficulties after pediatric cardiovascular surgery.
OBJECTIVE
To evaluate the impact of vocal cord dysfunction on feeding in children after cardiovascular surgery.


METHODS
Of the 2255 children who had cardiovascular surgery between January 2000 to January 2006, 38 (1.7%) had postoperative vocal cord dysfunction confirmed at laryngoscopy. The following data were obtained retrospectively: type of surgery, laryngoscopic examination results, swallowing studies, upper gastrointestinal (UGI) studies, and feeding route: oral, nasogastric tube (NG), and gastrostomy.


RESULTS
Surgeries included aortic arch reconstruction (n = 20), patent ductus arteriosus ligation (n = 8), arterial switch (n = 3), cervical cannulation for extracorporeal membrane oxygenation (n = 2), and others (n = 5). A swallowing study confirmed dysfunction in 27 of 29 patients. Gastrostomy was placed in 18/38 patients. At discharge, 18 patients were fed by gastrostomy, 13 orally, 3 by NG, and 4 by combination oral/NG. At a median follow-up of 12 months, 20 were fed orally, 1 by NG, 7 by gastrostomy, 7 by combination gastrostomy/orally, 1 was lost to follow-up, 2 died.


CONCLUSIONS
Vocal cord dysfunction after pediatric cardiovascular surgery is associated with significant feeding problems and may require prolonged gastrostomy feeding. These findings support aggressive surveillance for vocal cord dysfunction, especially in patients undergoing aortic arch surgery.
Sachdeva
Ritu
R
Department of Pediatrics, Division of Pediatric Cardiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. sachdevaritu@uams.edu
Hussain
Elora
E
Moss
M Michele
MM
Schmitz
Michael L
ML
Ray
Richard M
RM
Imamura
Michiaki
M
Jaquiss
Robert D B
RD
D001013:Aorta, Thoracic / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005248:Feeding Methods; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal; D007828:Laryngoscopy; D012189:Retrospective Studies; D014139:Tracheostomy; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000209:etiology*