Vocal cord dysfunction after cardiac surgery: an overlooked complication

To evaluate the complication of vocal cord dysfunction following open heart surgery and its short- and long-term effects.

Five cases (1.9%) of vocal cord dysfunction which were diagnosed among 270 cases of adult open heart surgery performed at this centre between February 1993 and May 1995.

All five patients developed respiratory insufficiency following tracheal extubation. They required reintubation and ventilation. Diagnosis was delayed in three cases because of unawareness of the problem. Tracheostomy was performed in three cases and minitracheostomy in two. In one case, shortness of breath on exertion persisted due to partial laryngeal obstruction from bilateral cord paresis and required arytenoidectomy 11 months postoperatively.

Vocal cord dysfunction can be an easily overlooked complication after open heart surgery. It can be the cause of respiratory insufficiency following tracheal extubation and may lead to reintubation and reventilation. The cause of the problem cannot always be traced but it may be due to direct trauma of the vocal cords during tracheal intubation, or trauma of the recurrent laryngeal nerve from the cuff of the endotracheal tube. A less likely possibility is that it may result from nerve injury due to central venous cannulation, or from cold. The condition may resolve within months, but, in rare cases, may lead to permanent morbidity.