Laryngopharyngeal dysfunction after the Norwood procedure

Abstract

After a Norwood procedure, swallowing dysfunction occurs in 48% of patients, with aspiration in 24%, and results in increased length of hospital stay. Left recurrent laryngeal nerve injury, seen in 9% of patients, is an uncommon cause of swallowing dysfunction. Postoperative aspiration generally resolves over time, whereas vocal fold paralysis does not. Systematic evaluation of swallowing function allows appropriate tailoring of feeding regimens and might contribute to decreased hospital and interstage mortality.

Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-called iatrogenic Ortner’s (cardiovocal) syndrome

“…Totally 50 reported were collected, including 19 (38%) case reports or case series [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], 1 (2%) technique [30], 17 (34%) retrospective [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] and 13 (26%) prospective reports [7,11,[49][50][51][52][53][54][55][56][57][58][59].…”

“…Is has been reported that the prevalence of left vocal cord paralysis after PDA ligation was 4.2% of the whole patient population, and it was 8.0% in infants with low birth weights [32]. The intraoperative damage to the left recurrent laryngeal nerve along its course around the PDA during the dissection of the nerve might result in stretch injury [55]. Røksund et al [11] found that infants with left vocal cord paralysis had a lower birth weight, longer duration of ventilation, and the greater proportion with bronchopulmonary dysplasia.…”

Nutritional Approach of Pediatric Patients Diagnosed with Congenital Heart Disease

“…Management of these cases includes thickening feeds to nectar or honey consistency, feeding positioning (right side down), and/or supplemental/sole tube feeding [26,[28][29][30][31][32][33][34][35].…”

“…Nutrition measures to be considered in these cases are: fl uid restriction, concentrated formula caloric density or parenteral nutrition, using formulas low in electrolytes, and in case of dialysis -supplement with water soluble vitamins and trace elements, providing 2-3 g/kg/day protein for continuous renal replacement therapy and 4 g/kg/day for peritoneal dialysis [26,[28][29][30][31][32][33][34][35].…”

“…Nutrition measures to be followed in these cases are: limit dietary long-chain triglycerides for up to 6 weeks after surgery by off ering very high medium-chain triglycerides formula for infants or a diet very low (< 10 g/day) in total fat for toddlers and children; breast milk can be skimmed with a centrifuge, then fortifi ed with high medium-chain triglycerides formula or oil; ensure 2-4% of calories from long chain fat to prevent essential fatty acid defi ciency; ensure adequate protein, electrolyte, and vitamin intake, as nutrients are lost in chyle drained via chest tube; parenteral nutrition may be required in cases refractory to nutrition and medical management [26,[28][29][30][31][32][33][34][35].…”