Daniel Farishta, MD, Shabih Manzar, MD, Ramachandra Bhat, MD
Short Clinical Vignette:
A preterm infant underwent transcatheter closure of patent ductus arteriosus (PDA). Based on angiographic findings, a 5.2 mm Amplatzer Piccolo Occluder device was chosen and delivered in an intraductal position (Figure 1, panel A). Postoperatively, the infant developed feeding difficulty. The modified barium swallow study showed silent aspiration of nectar liquid (Video, Figure 2). Nasolaryngoscopy performed by the Otolaryngologist revealed left true vocal fold (TVF) paralysis with limited adduction.
Discussion:
The plausible mechanism of left TFV paralysis noted after PDA closure is the impingement on the left recurrent laryngeal nerve (LRLN). LRLN runs in close proximity to PDA, looping back on it (Figure 1, panel B). We postulated that as the retention disc diameter of the Amplatzer Piccolo Occluder device used was larger than the preoperative PDA diameter, 5.2 mm versus 2.9 mm, it would have impinged the LRLN (device cross-section shown in the illustration). The other possibility would be the entrapment of the LRLN between the dilated left pulmonary artery and the device.
Figure 1:
Panel A- Echocardiogram showing Amplatzer Piccolo Occluder device in situ.
Panel B- Diagrammatic representation of Amplatzer Piccolo Occluder device compressing and impinging the LRLN (Figure adapted from Ryan et al. Neoreviews. 2020;21(5):e308-e322)
Figure 2:
Modified barium swallow study still images showing aspiration (white arrows) of nectar liquid
Video:
Modified barium swallow study showing aspiration of nectar liquid.
References:
- Tanidir IC, Yukcu B, Ozturk E, Guzeltas A. Vocal cord paralysis after transcatheter patent ductus arteriosus closure with AMPLATZERTM Vascular Plug II. Anatol J Cardiol. 2019;21(6):345-346. doi:10.14744/AnatolJCardiol.2019.88393
- Hwang MS, Su WJ. Iatrogenic cardiovocal syndrome caused by transcatheter coil closure of patent ductus arteriosus. Acta Paediatr. 2005;94(3):372-374. doi:10.1111/j.1651-2227.2005.tb03083.x
- Ryan MA, Upchurch PA, Senekki-Florent P. Neonatal Vocal Fold Paralysis. Neoreviews. 2020;21(5):e308-e322. doi:10.1542/neo.21-5-e308
Conflict of Interest: None
Funding Source: None
Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.
Daniel Farishta, MD
Resident Physician PGY-3,
Otolaryngology-Head & Neck Surgery
School of Medicine
Louisiana State University Health Sciences Center
1501 Kings Highway
Shreveport, LA 71103
Corresponding Author
Shabih Manzar, MD, MPH
Attending
Department of Pediatrics
Division of Neonatology
College of Medicine
Louisiana State University of Health Sciences
1501 Kings Highway
Shreveport, LA 71130
Telephone: 318-626-1623
Fax: 318-698-4305
Email: shabih.manzar@lsuhs.edu
Ramachandra Bhat, MD
Attending
Department of Pediatrics
Division of Neonatology
College of Medicine
Louisiana State University of Health Sciences
1501 Kings Highway
Shreveport, LA 71130
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