日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 35(3): 197-201 (2019)
doi:10.9794/jspccs.35.197

症例報告Case Report

鎮静と呼吸管理による保存的治療で寛解した心臓術後両側声帯麻痺Uneventful Recovery from Bilateral Vocal Cord Paralysis Following Cardiac Surgery Using Only Conservative Management

慶應義塾大学医学部小児科Department of Pediatrics, School of Medicine, Keio University ◇ Tokyo, Japan

受付日:2018年9月27日Received: September 27, 2018
受理日:2019年4月10日Accepted: April 10, 2019
発行日:2019年9月1日Published: September 1, 2019
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純型肺動脈閉鎖に対し両方向性Glenn手術を行った7か月男児.術後3時間(挿管後8時間)に抜管したところ,吸気性喘鳴と陥没呼吸を認めた.喉頭内視鏡検査で両側声帯の正中位固定を確認し,両側声帯麻痺と診断した.声門を動かす内喉頭筋のうち,声門を開大する唯一の筋である後輪状披裂筋は喉頭背側・食道腹側に位置する.本症例では,気管チューブ留置の刺激に加えて,術中の経食道エコープローブ挿入により,繰り返し後輪状披裂筋に外力が加わった結果,局所炎症から一過性麻痺を生じたと推測された.そこで,再挿管による声帯へのさらなる侵襲は逆効果と考え,呼吸抑制を生じない程度の軽度鎮静下で全身管理を続けた.抜管後4週間で両側声帯麻痺は改善し,喘鳴は消失した.症状,経過,内視鏡検査所見などから病態をより具体的に推定し,治療戦略の選択を行ったことが重要である.

A 7-month-old boy with pulmonary atresia and an intact ventricular septum underwent a bidirectional Glenn operation. Perioperative intubation lasted for 8 hours, and immediately after extubation, the boy presented with severe inspiratory stridor and chest retraction. Diagnosis of bilateral vocal cord paralysis was made based on the findings of flexible laryngoscopy, which revealed vocal cords fixed in the medial position. We speculated that the posterior cricoarytenoid muscle, the only internal laryngeal muscle that opens the vocal cords, was compressed between the tracheal tube and transesophageal echocardiography probe during treatment. The repetitive mechanical compression may have then caused muscle damage that resulted in bilateral vocal cord paralysis. Re-intubation was avoided considering that it would result in further airway damage; therefore, we placed the boy under mild sedation that did not suppress spontaneous breathing. Over the following 4 weeks, the respiratory symptoms gradually alleviated and improvement of vocal cord mobility was confirmed by laryngoscopy. The optimal treatment strategy in cases of vocal cord paralysis is selected according to the clinical presentation. However, evaluation of the underlying pathophysiological mechanisms by laryngoscopy may be vital.

Key words: vocal cord paralysis; cardiovascular surgery; complication; infant; Glenn operation

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This page was last modified on 2019-09-18T15:27:35.000+09:00


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