{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T17:59:05Z","timestamp":1772128745733,"version":"3.50.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,6,15]],"date-time":"2025-06-15T00:00:00Z","timestamp":1749945600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,15]],"date-time":"2025-06-15T00:00:00Z","timestamp":1749945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The Norwood operation is associated with postoperative complications including vocal cord dysfunction (VCD). This multicenter study evaluates VCD prevalence, risk factors, and diagnostic practices in a high-risk population. We performed a retrospective review of data from the National Pediatric Cardiology Quality Improvement Collaborative registry, examining infants who underwent the Norwood operation (S1P) with a surgical shunt and either completed stage 2 palliation or died after S1P discharge. The primary outcome was the endoscopic diagnosis of VCD after Norwood operation. Analysis of patient characteristics, operative details, and postoperative outcomes was performed to identify associations with VCD. Center variation in VCD was also assessed. Among the 2342 infants, VCD was diagnosed in 21.7%. Aortic arch reintervention (AAR) occurred in 19% and was associated with higher odds of VCD (OR 1.525,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001). Infants with VCD had higher rates of G-tube placement (42% vs. 22%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), though tracheostomy was uncommon (3.3%). Center analysis revealed lower rates of VCD at higher volume centers. Over time, AAR rates declined while VCD diagnoses increased. Our findings suggest that the Norwood operation plays a significant role in the development of VCD. The link between AAR and VCD is complex but may be influenced by institutional differences in evaluation practices. Given its impact on feeding and potential for persistence, VCD represents an important postoperative complication. Comprehensive postoperative care, low threshold to screen for VCD, and a multidisciplinary approach to management is needed to continually improve outcomes in infants undergoing the Norwood operation.\n                  <\/jats:p>","DOI":"10.1007\/s00246-025-03919-0","type":"journal-article","created":{"date-parts":[[2025,6,15]],"date-time":"2025-06-15T07:30:33Z","timestamp":1749972633000},"page":"1451-1458","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Vocal Cord Dysfunction in Infants Following the Norwood Operation: A National Pediatric Cardiology Quality Improvement Collaborative Analysis"],"prefix":"10.1007","volume":"47","author":[{"given":"Liza","family":"Hashim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"Chaves","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Conaway","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Vergales","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,15]]},"reference":[{"issue":"4","key":"3919_CR1","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1016\/j.athoracsur.2012.01.009","volume":"94","author":"K Averin","year":"2012","unstructured":"Averin K, Uzark K, Beekman RH, Willging JP, Pratt J, Manning PB (2012) Postoperative assessment of laryngopharyngeal dysfunction in neonates after Norwood operation. Ann Thorac Surg 94(4):1257\u20131261. https:\/\/doi.org\/10.1016\/j.athoracsur.2012.01.009","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"3919_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jsha.2015.05.00","volume":"28","author":"FA Alfares","year":"2016","unstructured":"Alfares FA, Hynes CF, Ansari G, Chounoune R, Ramadan M, Shaughnessy C et al (2016) Outcomes of recurrent laryngeal nerve injury following congenital heart surgery: a contemporary experience. J Saudi Heart Assoc 28(1):1\u20136. https:\/\/doi.org\/10.1016\/j.jsha.2015.05.00","journal-title":"J Saudi Heart Assoc"},{"issue":"9","key":"3919_CR3","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1097\/PCC.0000000000002010","volume":"20","author":"SC Gorantla","year":"2019","unstructured":"Gorantla SC, Chan T, Shen I, Wilkes J, Bratton SL (2019) Current epidemiology of vocal cord dysfunction after congenital heart surgery in young infants. Pediatr Crit Care Med 20(9):817. https:\/\/doi.org\/10.1097\/PCC.0000000000002010","journal-title":"Pediatr Crit Care Med"},{"issue":"3","key":"3919_CR4","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.jpeds.2007.03.014","volume":"151","author":"R Sachdeva","year":"2007","unstructured":"Sachdeva R, Hussain E, Moss MM, Schmitz ML, Ray RM, Imamura M et al (2007) Vocal cord dysfunction and feeding difficulties after pediatric cardiovascular surgery. J Pediatr 151(3):312-315.e2. https:\/\/doi.org\/10.1016\/j.jpeds.2007.03.014","journal-title":"J Pediatr"},{"issue":"5","key":"3919_CR5","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1016\/j.otohns.2007.07.028","volume":"137","author":"MT Truong","year":"2007","unstructured":"Truong MT, Messner AH, Kerschner JE, Scholes M, Wong-Dominguez J, Milczuk HA et al (2007) Pediatric vocal fold paralysis after cardiac surgery: rate of recovery and sequelae. Otolaryngol Neck Surg 137(5):780\u2013784. https:\/\/doi.org\/10.1016\/j.otohns.2007.07.028","journal-title":"Otolaryngol Neck Surg"},{"key":"3919_CR6","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.athoracsur.2017.03.080","volume":"1","author":"K Pourmoghadam","year":"2017","unstructured":"Pourmoghadam K, DeCampli W, Ruzmetov M, Kosko J, Kishawi S, O\u2019Brien M et al (2017) Recurrent laryngeal nerve injury and swallowing dysfunction in neonatal aortic arch repair. Ann Thorac Surg 1:104. https:\/\/doi.org\/10.1016\/j.athoracsur.2017.03.080","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"3919_CR7","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1053\/j.jvca.2016.08.002","volume":"30","author":"MS Raut","year":"2016","unstructured":"Raut MS, Maheshwari A, Joshi R, Joshi R, Dubey S, Shivnani G et al (2016) Vocal cord paralysis after cardiac surgery and interventions: a review of possible etiologies. J Cardiothorac Vasc Anesth 30(6):1661\u20131667. https:\/\/doi.org\/10.1053\/j.jvca.2016.08.002","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"2","key":"3919_CR8","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000005959","volume":"31","author":"MD Evman","year":"2020","unstructured":"Evman MD, Selcuk AA (2020) Vocal cord paralysis as a complication of endotracheal intubation. J Craniofac Surg 31(2):e119. https:\/\/doi.org\/10.1097\/SCS.0000000000005959","journal-title":"J Craniofac Surg"},{"issue":"3","key":"3919_CR9","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1002\/lary.29817","volume":"132","author":"A Narawane","year":"2022","unstructured":"Narawane A, Rappazzo C, Hawney J, Clason H, Roddy DJ, Ongkasuwan J (2022) Vocal fold movement and silent aspiration after congenital heart surgery. Laryngoscope 132(3):701\u2013705. https:\/\/doi.org\/10.1002\/lary.29817","journal-title":"Laryngoscope"},{"issue":"4","key":"3919_CR10","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1001\/archotol.131.4.336","volume":"131","author":"SS Khariwala","year":"2005","unstructured":"Khariwala SS, Lee WT, Koltai PJ (2005) Laryngotracheal consequences of pediatric cardiac surgery. Arch Otolaryngol Neck Surg 131(4):336. https:\/\/doi.org\/10.1001\/archotol.131.4.336","journal-title":"Arch Otolaryngol Neck Surg"},{"issue":"9","key":"3919_CR11","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1016\/j.ijporl.2006.05.001","volume":"70","author":"KD Pereira","year":"2006","unstructured":"Pereira KD, Webb BD, Blakely ML, Cox CS, Lally KP (2006) Sequelae of recurrent laryngeal nerve injury after patent ductus arteriosus ligation. Int J Pediatr Otorhinolaryngol 70(9):1609\u20131612. https:\/\/doi.org\/10.1016\/j.ijporl.2006.05.001","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"3919_CR12","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s00455-016-9775-x","volume":"32","author":"SE Langmore","year":"2017","unstructured":"Langmore SE (2017) History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia: changes over the years. Dysphagia 32(1):27\u201338. https:\/\/doi.org\/10.1007\/s00455-016-9775-x","journal-title":"Dysphagia"},{"issue":"2","key":"3919_CR13","doi-asserted-by":"publisher","first-page":"e370","DOI":"10.1542\/peds.2011-1188","volume":"129","author":"SK Pasquali","year":"2012","unstructured":"Pasquali SK, Li JS, Burstein DS, Sheng S, O\u2019Brien SM, Jacobs ML et al (2012) Association of center volume with mortality and complications in pediatric heart surgery. Pediatrics 129(2):e370\u2013e376. https:\/\/doi.org\/10.1542\/peds.2011-1188","journal-title":"Pediatrics"},{"issue":"6","key":"3919_CR14","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1016\/j.athoracsur.2023.08.006","volume":"116","author":"KF Welke","year":"2023","unstructured":"Welke KF, Karamlou T, O\u2019Brien SM, Dearani JA, Tweddell JS, Kumar SR et al (2023) Contemporary relationship between hospital volume and outcomes in congenital heart surgery. Ann Thorac Surg 116(6):1233\u20131239. https:\/\/doi.org\/10.1016\/j.athoracsur.2023.08.006","journal-title":"Ann Thorac Surg"},{"issue":"5","key":"3919_CR15","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1177\/0194599814522413","volume":"150","author":"V Pham","year":"2014","unstructured":"Pham V, Connelly D, Wei JL, Sykes KJ, O\u2019Brien J (2014) Vocal cord paralysis and dysphagia after aortic arch reconstruction and Norwood procedure. Otolaryngol Neck Surg 150(5):827\u2013833. https:\/\/doi.org\/10.1177\/0194599814522413","journal-title":"Otolaryngol Neck Surg"}],"container-title":["Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-025-03919-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00246-025-03919-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-025-03919-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T17:02:33Z","timestamp":1772125353000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00246-025-03919-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,15]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["3919"],"URL":"https:\/\/doi.org\/10.1007\/s00246-025-03919-0","relation":{},"ISSN":["0172-0643","1432-1971"],"issn-type":[{"value":"0172-0643","type":"print"},{"value":"1432-1971","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,15]]},"assertion":[{"value":"10 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}