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
Pediatric Cardiology and Cardiac Surgery 35(3): 197-201 (2019)

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


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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