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Laryngotracheal Consequences of Pediatric Cardiac Surgery
Samir S. Khariwala, MD;
Walter T. Lee, MD;
Peter J. Koltai, MD
Arch Otolaryngol Head Neck Surg. 2005;131:336-339.
Objective To determine the incidence and character of clinically significant laryngotracheal anomalies in pediatric patients undergoing surgical repair of congenital cardiac defects at a tertiary care center.
Design Single-center retrospective review.
Patients The charts of pediatric patients who required surgical treatment for congenital heart disease over a 4-year period were reviewed. Forty-eight of 1957 patients were seen in inpatient consultation by the otolaryngology service. The parameters studied included cardiac diagnosis, reason for consultation, findings on examination, and follow-up.
Results There were 16 (33%) cases of subglottic stenosis, which were graded according to the Cotton-Myer classification system as follows: grade 1 (n=8); grade 2 (n=3); and grade 3 (n=5). Three of the 16 patients with subglottic stenosis required tracheotomy and 4 required laryngotracheal reconstruction. Nine (19%) of the 48 patients were diagnosed as having unilateral true vocal cord paralysis and 3 (6%) as having bilateral paralysis. With the exception of 1 patient, all patients with true vocal cord paralysis on the left side had undergone repair of the aortic arch.
Conclusions Pediatric patients with congenital cardiac disease are predisposed to laryngeal anomalies owing to (1) frequent intubation, (2) prolonged ventilatory support, and (3) recurrent laryngeal nerve injury. In our patients, subglottic stenosis was the most common laryngeal abnormality. When recognized early, in the eschar phase, most of these cases can be managed with sequential endoscopic debridement, which is conceptually similar to debridement that is performed after functional endoscopic sinus surgery. Established stenosis requires more vigorous intervention, the invasive degree of which depends on the length and circumference of the narrowing. Unilateral vocal paralysis tends to be a self-limited problem, while an elegant solution to bilateral paralysis remains elusive.
Author Affiliations: Cleveland Clinic Foundation, Head and Neck Institute, Cleveland, Ohio (Drs Khariwala and Lee); and Division of Pediatric Otolaryngology, Stanford University School of Medicine, Stanford, Calif (Dr Koltai).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Airway Pathologic Abnormalities in Symptomatic Children With Congenital Cardiac and Vascular Disease
Guillemaud et al.
Arch Otolaryngol Head Neck Surg 2007;133:672-676.
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