Vocal cord dysfunction after cardiac surgery: an overlooked complication

Abstract

Vocal cord dysfunction can be an easily overlooked complication after open heart surgery. It can be the cause of respiratory insufficiency following tracheal extubation and may lead to reintubation and reventilation. The cause of the problem cannot always be traced but it may be due to direct trauma of the vocal cords during tracheal intubation, or trauma of the recurrent laryngeal nerve from the cuff of the endotracheal tube. A less likely possibility is that it may result from nerve injury due to central venous cannulation, or from cold. The condition may resolve within months, but, in rare cases, may lead to permanent morbidity.

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

“…The etiology of vocal cord dysfunction following open heart surgery remains unclear [8]. Shaw and Pierce [6] recommended that indirect injury by large double-lumen endotracheal tubes or transesophageal probes, phrenic or vague nerve injury associated with cooling and cardioplegic infusion, and excessive traction due to sternal retraction are the main causes of vocal fold paralysis subsequent cardiac surgery.…”

“…Recurrent laryngeal nerve injury can be caused by traumatic injury from central venous line insertion [8]. The right internal jugular vein is usually used as a route for central venous catheterization as the anatomical continuity with the superior vena cava.…”

“…Spontaneous recovery of hoarseness may take place within weeks, but in some cases, hoarseness would persist and the damage to the nerves remains permanent [8]. For prevention of nerve injury in the aortic aneurysm repair, "pull through technique", i.e., distal anastomosis to the prosthetic graft performed in the left pleural cavity, and the prosthetic graft pulled into the pericardial cavity through an aortic tunnel may be helpful [71].…”

“…Hoarseness lasted 4 ± 3 (1-14) days, and an additional patient with left vocal cord paralysis lasting 60 days. Except for hoarseness, stridor, difficulty in expectoration, dysphagia, and aspiration were the common symptoms in such patients [8]. In infants, they often manifested stridor and feeding difficulty and both required feeding tubes [9].…”

The Use of Botox in the Treatment of Post Cardiac Surgery Paradoxical Vocal Cord Movement

“…Paradoxical vocal cord movement has been diagnosed with increased frequency in subjects with asthma sometimes leading to unnecessary courses of systemic steroids and even intubation and mechanical ventilation. Another form of PVCM has been described in association with cardiac surgery [2]. Its occurrence has been related to different mechanisms related to the surgical intervention [2].…”