Ultrasonographic assessment for vocal cord function after pediatric aortic arch reconstruction

Abstract

Objective: Vocal cord paralysis due to recurrent laryngeal nerve injury is a well-known complication in infants and children undergoing aortic arch reconstruction. The “gold standard” modality for examining vocal cords is direct flexible laryngoscopy; however, here we report our experiences with vocal cord ultrasonography after pediatric aortic arch reconstruction. Methods: Seven patients with voice hoarseness after aortic arch reconstruction at Hyogo Prefectural Kobe Children's Hospital between October 2017 and January 2019 underwent bedside ultrasonography for the assessment of vocal cord movement. Subsequently, flexible laryngoscopy was performed to confirm the ultrasonographic findings. Results: Aortic arch reconstruction was performed in five patients with coarctation of the aorta complex, one patient with interrupted aortic arch complex, and one patient with hypoplastic left heart syndrome. Vocal cord ultrasonography revealed left vocal cord paralysis in six patients and normal vocal cords in one patient. In six of the seven patients, the ultrasonographic findings corresponded with the results of flexible laryngoscopy. Median duration between postoperative tracheal extubation and bedside ultrasonography was 2 days. Conclusions: Bedside ultrasonography for vocal cord movement is useful for the early evaluation of postoperative vocal cord paralysis in infants and children. It can be used as an alternative to flexible fiberoptic laryngoscopy for the initial assessment of postoperative vocal cord function after pediatric cardiac surgery.