Laryngeal Ultrasound for Identifying Vocal Fold Motion Impairment after Pediatric Heart Surgery

Background: Due to the anatomical characteristics of the left recurrent laryngeal nerve (RLN), there is a potential risk of its intraoperative injury during pediatric cardiac surgery. This can result in vocal fold motion impairment (VFMI), leading to subsequent respiratory and feeding problems. Most commonly, VFMI occurs after surgical procedures requiring extensive aortic arch reconstruction, with the left side being more frequently affected. Usually, the VFMI is diagnosed by laryngoscopy, which is currently considered the gold standard. Laryngeal ultrasound is a promising non-invasive alternative to the laryngoscopy. The aim of our study was to assess the practicability and reliability of laryngeal ultrasound for the detection of VFMI following cardiac surgery.

Methods: We performed an observational pilot study from June 2022 until July 2023 on pediatric patients with upper airway symptoms after the extubation, such as stridor and/or low voice, suspected of having VFMI. All of the children included in the analysis underwent cardiac surgery. After the extubation, we performed a laryngeal ultrasound to assess the vocal fold movement as a screening method. The findings were verified using a laryngoscopy as a gold standard.

Results: During the investigated period of 13 month, we identified 11 out of 218 children with persistent upper airway symptoms after the extubation with median age of 196 (19–235) days and median weight of 4,460 (3,300–7,000) g. The laryngeal ultrasound revealed a left VFMI in 7 patients, which makes an overall incidence of 3.2% for the study period. Laryngoscopy was performed on all seven patients, which confirmed the diagnosis. The subgroup analysis revealed an incidence of VFMI after persistent ductus ligation 2/6 (33%), followed by aortic arch repair 2/8 (25%), and Norwood procedure 2/11 (18%).

Conclusion: Pediatric heart surgery involving the aortic arch is associated with a risk of developing VFMI, which can complicate the recovery process. According to our experience laryngeal ultrasound can be successfully applied as a screening method, enabling early diagnosis and introduction of supportive therapy. To evaluate the course of VFMI, this diagnostic procedure could be performed during follow-up echocardiography, without the need for invasive interventions. However, further investigations are required to assess the potential of this method in clinical settings.

Publication History

Article published online:
13 February 2024