Objectives
Determine the incidence of vocal cord paralysis and dysphagia after aortic arch reconstruction including Norwood procedure.
Setting
Tertiary Children’s Hospital
Study Design
Retrospective cohort.
Methods
Database/chart review of neonates requiring Norwood or arch surgery between January 2005 through December 2012. Demographics, postoperative vocal cord function, dysphagia, need for gastrostomy tube and/or tracheotomy, and long-term follow-up were reviewed.
Results
One hundred fifty-one consecutive subjects(96 Norwood, 55 aortic arch) were reviewed. Median age at repair was 9 days(IQR 7–13) for Norwood, 24 days(IQR 12–49) for arch reconstruction(p<0.001). Documentation of VC motion abnormality was found in 60/104(57.6%) subjects, and unavailable in 47:16 without documentation and 31 who expired prior to extubation. There were no significant differences in proportions of documented VC motion(p=0.337), dysphagia(p=0.987), and VC paralysis(p=0.706) between the arch and Norwood groups. Dysphagia was found in 73.5% of Norwood and 69.2% of arch subjects who had documented VC paralysis. Even without UVCP, dysphagia was present (56% Norwood,61% arch). Overall, 120/151(79.5%) required feeding evaluation and modified feeding regimen. Gastrostomy was required in 31% of Norwood and 23.6% of arch reconstruction overall. To date, mortality in this series is 55/151(36.4%) patients. Of those with VC paralysis, only 23(22%) had any otolaryngology follow-up after discharge from surgery. Over 75% with VC paralysis with follow-up after hospital discharge had persistent VC paralysis 11.5 months after diagnosis.
Conclusion
There is high incidence of UVCP and dysphagia after Norwood and arch reconstruction. Dysphagia was highly prevalent in both groups even without UVCP. Preoperative discussion on vocal cord function and dysphagia should be considered.
Background-The relationship of atrioventricular nodal reentrant tachycardia to congenital heart disease (CHD) and the outcome of catheter ablation in this population have not been studied adequately. Methods and Results-A multicenter retrospective study was performed on patients with CHD who had atrioventricular nodal reentrant tachycardia and were treated with catheter ablation. There were 109 patients (61 women), aged 22.1±13.4 years. The majority, 86 of 109 (79%), had CHD resulting in right heart pressure or volume overload. Patients were divided into 2 groups: group A (n=51) with complex CHD and group B (n=58) with simple CHD. There were no significant differences between groups in patients' growth parameters, use of 3-dimensional imaging, and type of ablation (radiofrequency versus cryoablation
The effectiveness of a eutectic mixture of the local anaesthetics lignocaine and prilocaine (EMLA cream) in relieving artificially induced pruritus was examined in 20 volunteers. The study was conducted in two parts. In part one, the effect of EMLA on the threshold concentration of histamine necessary to induce pruritus was assessed by a double-blind placebo controlled method. In part two, the effect of EMLA on the perception of pruritus induced by the artificial pruritogens cowhage and papain was assessed by a single blind method. Some subjects were less sensitive to histamine after placebo cream treatment, but all subjects showed a marked reduction in sensitivity to histamine after EMLA treatment. The difference between EMLA and the placebo treatment was statistically significant. The EMLA preparation was found to be effective in alleviating pruritus induced by cowhage and papain and this effect was also statistically significant. Thus, EMLA cream was found to be effective in reducing experimentally induced pruritus and, therefore, may be useful in some clinical circumstances where persistent itch is a distressing symptom.
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