Incidence, Risk Factors, and Comorbidities of Vocal Cord Paralysis After Surgical Closure of a Patent Ductus Arteriosus: A Meta-analysis

Henry, Brandon Michael; Hsieh, Wan Chin; Sanna, Beatrice; Vikse, Jens; Taterra, Dominik; Tomaszewski, Krzysztof A.

doi:10.1007/s00246-018-1967-8

Cited by 40 publications

(35 citation statements)

References 37 publications

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“…Results from two metanalyses evaluating the incidence of VCP after surgical closure of PDA revealed an increased occur-rence of VCP in preterm infants (9% and 11.7%) particularly in neonates with low birth weight, low gestational age, and low weight at the time of surgery. [7][8][9] However, none of the above-mentioned complications were encountered in our study.…”

Section: Vanamo Et Al Published a Study Comparing Vatscontrasting

confidence: 53%

The outcome of PDA ligation by mini-thoracotomy in premature neonates: A single hospital experience

et al. 2020

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Background: Various thoracotomy practices have been employed for occlusion of patent ductus arteriosus (PDA) which are not amenable to medical management. We report our preliminary experience of using a mini-thoracotomy approach in small premature infants and determining survival outcomes in relation to factors such as gender, birth weight, age, and type of ventilation used intraoperatively. Methods: Between January 2004 and December 2012, 52 consecutive premature infants with an echocardiographic diagnosis of isolated PDA, which are not amenable to medical treatment, were included. Those with chromosomal abnormalities, major cardiac congenital anomalies aside from septal defects, and infants who did not receive mechanical ventilation in the first week of life were excluded. The median gestational age was 28 weeks and the median gestational weight at surgery was 705g. The median PDA size was 3.8mm, ranging from 1.6 to 5mm. Twenty-nine patients were given non-selective ventilation and twenty-three were anesthetized using selective right-lung ventilation using a 2-F balloon catheter for arterial embolectomy. A left lateral mini-thoracotomy was performed in all infants and PDA closure achieved by double ligation using zero silk sutures. Results: The median operative time and mean length of hospital stay were 45 minutes and 90 days, respectively. No major hemorrhage requiring blood transfusion occurred during the surgery. The survival rate until hospital discharge was 88.5%. There were no mortalities associated with the surgery itself. Six (11.5%) neonates died postoperatively because of prematurity (p-value=1.000). Pneumonia and atelectasis were among the few complications encountered post ligation. An interesting association was recognized between ventilation and surgical complications; that is neonates who underwent selective right ventilation did not experience any of the complications mentioned above in comparison to those who were put under non-selective ventilation (p-value <0.001). Conclusion: Closure of PDA by double ligation via a left mini-thoracotomy in small premature infants proved to be safe and effective in providing pediatric surgeons adequate exposure within confined and delicate anatomic spaces. No mortalities or major complications were encountered.

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Section: Vanamo Et Al Published a Study Comparing Vatscontrasting

confidence: 53%

The outcome of PDA ligation by mini-thoracotomy in premature neonates: A single hospital experience

et al. 2020

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“…We present a case of LRLN palsy following stent implantation in the transverse aortic arch. Vocal cord paresis is a well-known complication of surgical ligation of patent ductus arteriosus[7], and has also been described secondary to transcatheter closure of patent ductus arteriosus and left pulmonary artery stenting[8-12]. Moreover, LRLN palsy has also occurred after surgical aortic arch reconstruction during the Norwood procedure[13].…”

Section: Discussionmentioning

confidence: 99%

Left recurrent laryngeal nerve palsy following aortic arch stenting: A case report

Fürniss

Hummel

Stiller

et al. 2019

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BACKGROUNDAortic arch stenting is continuously emerging as a safe and effective option to alleviate aortic arch stenosis and arterial hypertension.CASE SUMMARYWe present a 15-year-old girl with aortic arch hypoplasia who had undergone implantation of an uncovered 22 mm Cheatham-Platinum stent due to severe (native) aortic arch stenosis. On follow-up seven months later, she presented a significant re-stenosis of the aortic arch. A second stent (LD Max 26 mm) was implanted and both stents were dilated up to 16 mm. After an initially unremarkable post-interventional course, the patient presented with hoarseness five days after the intervention. MRI and CT scans ruled out an intracranial pathology, as well as thoracic hematoma, arterial dissection, and aneurysm around the intervention site. Laryngoscopy confirmed left vocal fold paresis attributable to an injury to the left recurrent laryngeal nerve (LRLN) during aortic arch stenting, as the nerve loops around the aortic arch in close proximity to the area of the implanted stents. Following a non-invasive therapeutic approach entailing regular speech therapy, the patient recovered and demonstrated no residual clinical symptoms of LRLN palsy after six months.CONCLUSIONLeft recurrent laryngeal nerve palsy is a rare complication of aortic arch stenting not previously reported.

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“…Although LVCP is a well-described complication, an unknown fraction may pass unnoticed or are misinterpreted during the neonatal period as symptoms may be vague, transient and uncharacteristic (27,29,37,38,43). Importantly, we know that pediatric LVCP does not usually recover (11,(44)(45)(46). Therefore, symptoms may continue to be overlooked or erroneously related to other disorders or even to malingering, later in life.…”

Section: Discussionmentioning

confidence: 99%

Voice and Exercise Related Respiratory Symptoms in Extremely Preterm Born Children After Neonatal Patent Ductus Arteriosus

et al. 2020

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Objective: To investigate voice characteristics and exercise related respiratory symptoms in extremely preterm born 11-year-old children, focusing particularly on associations with management of a patent ductus arteriosus (PDA). Study design: Prospective follow-up of all children born in Norway during 1999-2000 at gestational age <28 weeks or with birthweight <1,000 g. Neonatal data were obtained prospectively on custom-made registration forms completed by neonatologists. Voice characteristics and exercise related respiratory symptoms were obtained at 11 years by parental questionnaires. Result: Questionnaires were returned for 228/372 (61%) eligible children, of whom 137 had no history of PDA. PDA had been noted in 91 participants, of whom 36 had been treated conservatively, 21 with indomethacin, and 34 with surgery. Compared to the children treated with indomethacin or conservatively, the odds ratio (95% confidence interval) for the surgically treated children were 3.4 (1.3; 9.2) for having breathing problems during exercise, 16.9 (2.0; 143.0) for having a hoarse voice, 4.7 (1.3; 16.7) for a voice that breaks when shouting, 4.6 (1.1; 19.1) for a voice that disturbs singing, and 3.7 (1.1; 12.3) for problems shouting or speaking loudly. The significance of surgery per se was uncertain since the duration of mechanical ventilation was associated with the same outcomes. Conclusion: Extremely preterm born children with a neonatal history of PDA surgery had more problems with voice and breathing during exercise in mid-childhood than those whose PDA had been handled otherwise. The study underlines the causal heterogeneity of exercise related respiratory symptoms in preterm born children.

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Incidence, Risk Factors, and Comorbidities of Vocal Cord Paralysis After Surgical Closure of a Patent Ductus Arteriosus: A Meta-analysis

Cited by 40 publications

References 37 publications

The outcome of PDA ligation by mini-thoracotomy in premature neonates: A single hospital experience

The outcome of PDA ligation by mini-thoracotomy in premature neonates: A single hospital experience

Left recurrent laryngeal nerve palsy following aortic arch stenting: A case report

Voice and Exercise Related Respiratory Symptoms in Extremely Preterm Born Children After Neonatal Patent Ductus Arteriosus

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