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

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.