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ABIGAIL RAJABENADIC UoB - Y2 Medical Student Research conducted at the Bristol Royal Hospital for Children

Vocal cord palsy following pAEdiatric cardiac surgery


Paediatric cardiac surgeries are performed to correct congenital heart defects, giving children the best possible chance at life. Despite its life-saving character, there is a certain risk that should be taken into consideration – Vocal cord palsy (VCP).Paediatric patients undergoing cardiac surgeries involving structures surrounding the aortic arch may be at risk of VCP due to the vulnerability of the Left Recurrent Laryngeal nerve (LRLN).

  • Surgeries involving the aortic arch, ligamentum arteriosum and the ductus arteriosus.
  • The LRLN is situated inferior to the aortic arch
and posterior to the ligamentum arteriosum, inducing its vulnerability during stated surgeries.

ImProper closure

Proper closure

  • VCP is characterised by paralysis or damage to one or both vocal cords - reducing their ability to abduct and adduct
  • Physiological implications of VCP can include aspiration while feeding, stridor, oral and pharyngeal dysphagia, among many others.

What is VCP ?

  • Access to Evolve, Care Flow and Heart Suite was granted
  • Consent forms were checked for any mention of VCP as a risk
  • Using the different patient record platforms, the current state of patients' VCP was checked
  • Any discharge, mortalities and open appointments were observed
  • SALT Clinics were observed
  • Was able to see how the progression of VCP is monitored and treatment changes that needed to be instilled
  • Parents' thoughts and concerns were also heard

NHS Database

SALT Clinic

Cardiac Surgery Department

  • A patient list between 6 months (01/07/2022 - 31/12/2022) was given in the form of an Excel spreadsheet.
  • To identify the patients who underwent cardiac surgery and were diagnosed with VCP, another patient list was acquired - from SALT/ENT



feeding to prevent aspiration
right-sided lying when
  • SALT advice in most cases:
  • VCP was not a mentioned risk on consent forms
  • Parents were largely unaware of the risk before consenting to procedures; informed consent not achieved


  • Similarity between patients: Procedures involving the aortic arch/structures surrounding


1 Calendar year

NHS Wales Database

Universal screening

The research only considered patients who were operated on within a single year. This decreases the number of cases that could be observed

Patient medical records from NHS Wales were not accessible for this research. Therefore, this presents as a loss-to-follow-up bias

No universal screening for VCP following paediatric cardiac surgeries that have a greater risk for VCP, meaning it was difficult to detect asymptomatic cases and the incidence recorded is likely to be an underestimate of the true burden of the disease

NHS Wales follow up

Asymptomatic patients

Implementation of routine post-operative flexible naso-endoscopy following surgeries that have a greater risk of VCP (as part of a clinical guideline) would ensure asymptomatic patients are givenadequate support

Consent Forms

Documentation of VCP as a specific complication of paediatric cardiac surgery on surgical consent forms would achieve informed consent

Follow-up data from NHS Wales, data from additional years, and document figures such as the number of additional hospital visits patients made


  • Other risks on consent forms include death, stroke and infection.
  • Frequency of VCP in surgeries concerning the aortic arch and structures surrounding is 4.6%
  • Guidance states that any complication with a frequency of over 1% should be mentioned during the consenting process
  • Parents and guardians are unaware of this risk and were poorly prepared for the outcome of the surgery


Acknowledgements: Consultant Congenital Cardiac Surgeon - Mr Shaffi Mussa Paediatric and Adult Consultant ENT Surgeon - Mr Julian Gaskin The Surgical staff at the Bristol Royal Hospital for Children