RESUMEN
Objective: Injury to the recurrent laryngeal nerve can lead to significant morbidity during congenital cardiac surgery. The objective is to expand on the limited understanding of the severity and recovery of this iatrogenic condition
Design: A six-year retrospective review of all congenital heart operations at a single institution from January 1, 2008 to December 31, 2013 was performed. All patients with documented vocal cord paralysis on laryngoscopic examination comprised the study cohort. Evaluation of time to vocal cord recovery and need for further surgical intervention was the primary focus
Results: The incidence of post-operative vocal cord paralysis was 1.1% [32 out of 3036 patients; 95% confidence interval: 0.7-1.5%]. The majority were left-sided injuries [71%]. Overall rate of recovery was 61% with a median time of 10 months in those who recovered, and a total follow up of 46 months. Due to feeding complications, 45% of patients required gastrostomy tube after the injury, and these patients were found to have longer duration of post-operative days of intubation [median 10 vs. 5 days, p = 0.03], ICU length of stay [50 vs. 8 days, p = 0.002], and hospital length of stay [92 vs. 41 days, p = 0.01]. No pre-operative variables were identified as predictive of recovery or need for gastrostomy placement
Conclusion: Recurrent laryngeal nerve injury is a serious complication of congenital heart surgery that impacts post-operative morbidity, in some cases leading to a need for further intervention, in particular, gastrostomy tube placement. A prospective, multi-center study is needed to fully evaluate factors that influence severity and time to recovery
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Cirugía Torácica , Estudios Retrospectivos , Parálisis de los Pliegues Vocales , Gastrostomía , Cardiopatías Congénitas/cirugía , Evaluación del Resultado de la Atención al PacienteRESUMEN
Menetrier's disease is a rare form of acquired gastropathy that presents mostly during adulthood, but is extremely rare in children. It is a clinicopathological diagnosis that typically presents with abdominal pain, vomiting, and edema secondary to hypoalbuminemia. Endoscopy usually shows giant gastric mucosal folds, and gastric biopsy shows foveolar hyperplasia and decreased oxyntic glands. Here, we describe a 5-year-old boy from Saudi Arabia with typical presentation of Menetrier's disease and serological evidence of acute cytomegalovirus infection