The incidence of recurrent laryngeal nerve injury resulting in vocal cord paralysis following interventional congenital catheterisation procedures

Abstract

Background: Recurrent laryngeal nerve injury leading to vocal cord paralysis is a known complication of cardiothoracic surgery. Its occurrence during interventional catheterisation procedures has been documented in case reports, but there have been no studies to determine an incidence. Objective: To establish the incidence of left recurrent laryngeal nerve injury leading to vocal cord paralysis after left pulmonary artery stenting, patent ductus arteriosus device closure and the combination of the procedures either consecutively or simultaneously. Methods: Members of the Congenital Cardiovascular Interventional Study Consortium were asked to perform a retrospective analysis to identify cases of recurrent laryngeal nerve injury after the aforementioned procedures. Twelve institutions participated in the analysis. They also contributed the total number of each procedure performed at their respective institutions for statistical purposes. Results: Of the 1337 patients who underwent left pulmonary artery stent placement, six patients (0.45%) had confirmed vocal cord paralysis. 4001 patients underwent patent ductus arteriosus device closure, and two patients (0.05%) developed left vocal cord paralysis. Patients who underwent both left pulmonary artery stent placement and patent ductus arteriosus device closure had the highest incidence of vocal cord paralysis which occurred in 4 of the 26 patients (15.4%). Overall, 92% of affected patients in our study population had resolution of symptoms. Conclusion: Recurrent laryngeal nerve injury is a rare complication of left pulmonary artery stent placement or patent ductus arteriosus device closure. However, the incidence is highest in patients undergoing both procedures either consecutively or simultaneously. Additional research is necessary to determine contributing factors that might reduce the risk of recurrent laryngeal nerve injury.

Left Pulmonary Artery Stenting for Left Pulmonary Artery Stenosis Following Patent Ductus Arteriosus Device Closure: Case Series and Review of the Literature

“…A particular complication of LPA stenting in the presence of a PDA device is the occurrence of vocal cord paralysis due to impingement of the left recurrent laryngeal nerve between the device and the LPA stent [ 27 ]. In a retrospective study regarding vocal cord paralysis after LPA stenting and/or PDA device closure, involving 5364 patients in 12 institutions, this complication was seen in 2/4001 cases of PDA device closure, in 6/1337 cases of LPA stenting, and in 4/26 cases of PDA device closure + LPA stenting (15%), with most of the cases recovering completely [ 28 ]. In our series, this complication was suspected in two patients, but symptoms were mild and transitory, so no further tests or particular management was considered necessary.…”

Transient Recurrent Laryngeal Nerve Palsy after Interventional Therapy

“…It is intriguing that also in this study, 92% of the patients showed resolution of symptoms; the only persistent vocal cord paralysis was observed in one patient who underwent LPA stent placement. 26 Dalili et al reported on interventional PDA closure by using radiofrequency ablation. In two out of six patients, a transient vocal cord palsy was detected.…”