{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:27:28Z","timestamp":1793384848367,"version":"4.5.0"},"reference-count":44,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,6,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVE:<\/jats:title>\n                  <jats:p>There is variation in the literature in regard to the occurrence of unilateral vocal fold paralysis (UVFP) after congenital cardiothoracic surgery. The objective of this study was to identify and appraise the evidence for the occurrence of UVFP after congenital cardiothoracic surgery in a meta-analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHOD:<\/jats:title>\n                  <jats:p>A comprehensive search strategy in Medline, Embase, and the Cochrane Library was conducted, limited to English publications. Two independent reviewers screened studies for eligibility criteria. Of the 162 identified studies, 32 (20%) met the inclusion criteria. Using the Oxford Centre for Evidence-Based Medicine guidelines, 2 reviewers appraised the level of evidence, extracted data, and resolved discrepancies by consensus. Weighted pooled proportion and 95% confidence intervals (CIs) are reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Thirty-two studies (n = 5625 patients) were included. Levels of evidence varied from level 3 to 4. Among all studies, the weighted pooled proportion of UVFP was 9.3% (95% CI, 6.6% to 12.5%), and among 11 studies (n = 584 patients) that postoperatively evaluated patients with flexible nasopharyngolaryngoscopy to document presence of UVFP, the weighted pooled proportion of UVFP was 29.8% (95% CI, 18.5% to 42.5%). Twenty-one studies (n = 2748 patients) evaluated patients undergoing patent ductus arteriosus ligation surgery, and the weighted pooled proportion of UVFP was 8.7% (95% CI, 5.4% to 12.6%). Six of these (n = 274 patients) assessed all patients postoperatively, and the weighted pooled proportion of UVFP was 39% (95% CI, 18% to 63%). Pooled analyses of risk factors and comorbidities are reported. Heterogeneity and publication bias were detected.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>UVFP is a demonstrated risk of congenital cardiothoracic surgery. Routine postoperative nasopharyngolaryngoscopy for vocal fold assessment by an otolaryngologist is suggested.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2013-3939","type":"journal-article","created":{"date-parts":[[2014,5,20]],"date-time":"2014-05-20T03:56:05Z","timestamp":1400558165000},"page":"e1708-e1723","source":"Crossref","is-referenced-by-count":68,"title":["Unilateral Vocal Fold Paralysis After Congenital Cardiothoracic Surgery: A Meta-analysis"],"prefix":"10.1542","volume":"133","author":[{"given":"Julie E.","family":"Strychowsky","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2013Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Rukholm","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2013Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada; and"},{"name":"Peterborough Regional Health Centre, Peterborough, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael K.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2013Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2013Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2014,6,1]]},"reference":[{"issue":"3","key":"2021121107053850300_B1","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jpeds.2006.12.048","article-title":"Patent ductus arteriosus: evidence for and against treatment.","volume":"150","author":"Clyman","year":"2007","journal-title":"J Pediatr"},{"issue":"1","key":"2021121107053850300_B2","first-page":"27","article-title":"Morphology of the patent arterial duct: features relevant to treatment.","volume":"10","author":"Matsui","year":"2008","journal-title":"Images Paediatr Cardiol"},{"key":"2021121107053850300_B3","first-page":"1505","article-title":"Neurogenic diseases of the larynx","volume-title":"Pediatric Otolaryngology","author":"Dedo","year":"2003","edition":"4th ed."},{"issue":"10","key":"2021121107053850300_B4","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jclinepi.2009.06.006","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.","volume":"62","author":"Liberati","year":"2009","journal-title":"J Clin Epidemiol"},{"key":"2021121107053850300_B5","unstructured":"OCEBM Levels of Evidence Working Group. The Oxford levels of evidence 2. Oxford Centre for Evidence-Based Medicine. Available at: www.cebm.net\/index.aspx?o=5653"},{"issue":"12","key":"2021121107053850300_B6","doi-asserted-by":"crossref","first-page":"2781","DOI":"10.1002\/lary.23575","article-title":"Incidence and implication of vocal fold paresis following neonatal cardiac surgery.","volume":"122","author":"Dewan","year":"2012","journal-title":"Laryngoscope"},{"issue":"1","key":"2021121107053850300_B7","doi-asserted-by":"crossref","first-page":"F39","DOI":"10.1136\/adc.2010.206052","article-title":"Outcomes following the surgical ligation of the patent ductus arteriosus in premature infants in Scotland.","volume":"97","author":"Heuchan","year":"2012","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"11","key":"2021121107053850300_B8","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1016\/j.ijporl.2012.07.036","article-title":"Vocal cord paralysis post patent ductus arteriosus ligation surgery: risks and co-morbidities.","volume":"76","author":"Rukholm","year":"2012","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"6","key":"2021121107053850300_B9","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1001\/archoto.2011.84","article-title":"Assessment of vocal fold mobility before and after cardiothoracic surgery in children.","volume":"137","author":"Carpes","year":"2011","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"6","key":"2021121107053850300_B10","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1038\/jp.2009.124","article-title":"Long-term morbidities associated with vocal cord paralysis after surgical closure of a patent ductus arteriosus in extremely low birth weight infants.","volume":"30","author":"Benjamin","year":"2010","journal-title":"J Perinatol"},{"key":"2021121107053850300_B11"},{"issue":"6","key":"2021121107053850300_B12","first-page":"A4160","article-title":"Surgical ligation of patent ductus arteriosus in premature infants.","volume":"57","author":"S\u00f8rensen","year":"2010","journal-title":"Dan Med Bull"},{"issue":"1","key":"2021121107053850300_B13","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/j.1747-0803.2008.00241.x","article-title":"Surgical closure of patent ductus arteriosus in preterm low birth weight infants.","volume":"4","author":"Mandhan","year":"2009","journal-title":"Congenit Heart Dis"},{"issue":"8","key":"2021121107053850300_B14","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1002\/lary.20148","article-title":"Should all newborns who undergo patent ductus arteriosus ligation be examined for vocal fold mobility?","volume":"119","author":"Smith","year":"2009","journal-title":"Laryngoscope"},{"issue":"10","key":"2021121107053850300_B15","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1177\/000348940911801011","article-title":"Unilateral vocal fold paralysis in premature infants after ligation of patent ductus arteriosus: vascular clip versus suture ligature.","volume":"118","author":"Spanos","year":"2009","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"5","key":"2021121107053850300_B16","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1111\/j.1747-0803.2009.00323.x","article-title":"Standardized management improves outcomes after the Norwood procedure.","volume":"4","author":"Srinivasan","year":"2009","journal-title":"Congenit Heart Dis"},{"issue":"1","key":"2021121107053850300_B17","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1001\/archoto.2007.2","article-title":"Unilateral vocal cord paralysis following patent ductus arteriosus ligation in extremely low-birth-weight infants.","volume":"134","author":"Clement","year":"2008","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"2","key":"2021121107053850300_B18","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s00246-007-9027-9","article-title":"Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries.","volume":"29","author":"Davis","year":"2008","journal-title":"Pediatr Cardiol"},{"issue":"3","key":"2021121107053850300_B19","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.jpeds.2007.03.014","article-title":"Vocal cord dysfunction and feeding difficulties after pediatric cardiovascular surgery","volume":"151","author":"Sachdeva","year":"2007","journal-title":"J Pediatr"},{"issue":"9","key":"2021121107053850300_B20","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1016\/j.ijporl.2006.05.001","article-title":"Sequelae of recurrent laryngeal nerve injury after patent ductus arteriosus ligation.","volume":"70","author":"Pereira","year":"2006","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"3","key":"2021121107053850300_B21","doi-asserted-by":"crossref","first-page":"210","DOI":"10.2459\/01.JCM.0000215275.55144.17","article-title":"Video-assisted thoracoscopic clipping of patent ductus arteriosus: close to the gold standard and minimally invasive competitor of percutaneous techniques.","volume":"7","author":"Villa","year":"2006","journal-title":"J Cardiovasc Med (Hagerstown)"},{"issue":"4","key":"2021121107053850300_B22","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1001\/archotol.131.4.336","article-title":"Laryngotracheal consequences of pediatric cardiac surgery.","volume":"131","author":"Khariwala","year":"2005","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"5","key":"2021121107053850300_B23","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1016\/j.jtcvs.2005.07.013","article-title":"Laryngopharyngeal dysfunction after the Norwood procedure.","volume":"130","author":"Skinner","year":"2005","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"2","key":"2021121107053850300_B24","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1017\/S1047951104002082","article-title":"Thoracoscopic closure of the patent arterial duct.","volume":"14","author":"Vida","year":"2004","journal-title":"Cardiol Young"},{"issue":"4","key":"2021121107053850300_B25","first-page":"315","article-title":"Predictors of oral feeding difficulty in cardiac surgical infants.","volume":"29","author":"Einarson","year":"2003","journal-title":"Pediatr Nurs"},{"issue":"5","key":"2021121107053850300_B26","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1016\/S0003-4975(03)00956-1","article-title":"The incidence of dysphagia in pediatric patients after open heart procedures with transesophageal echocardiography.","volume":"76","author":"Kohr","year":"2003","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"2021121107053850300_B27","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S0002-8703(03)00125-X","article-title":"Vocal cord paralysis after transcatheter coil embolization of patent ductus arteriosus.","volume":"146","author":"Liang","year":"2003","journal-title":"Am Heart J"},{"issue":"5\u20136","key":"2021121107053850300_B28","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1007\/s003830000515","article-title":"Surgical closure of patent ductus arteriosus in very-low-birth-weight infants.","volume":"17","author":"Niinikoski","year":"2001","journal-title":"Pediatr Surg Int"},{"issue":"1","key":"2021121107053850300_B29","first-page":"1","article-title":"The evolution of ductus arteriosus treatment.","volume":"85","author":"LeBlanc","year":"2000","journal-title":"Int Surg"},{"issue":"4","key":"2021121107053850300_B30","first-page":"358","article-title":"Is surgical closure of patent ductus arteriosus a safe procedure in premature infants?","volume":"83","author":"Russell","year":"1998","journal-title":"Int Surg"},{"issue":"6","key":"2021121107053850300_B31","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1016\/S0022-5223(96)70022-3","article-title":"Cost and efficacy of surgical ligation versus transcatheter coil occlusion of patent ductus arteriosus.","volume":"112","author":"Hawkins","year":"1996","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"3","key":"2021121107053850300_B32","first-page":"563","article-title":"Video-assisted thoracoscopic surgery for the treatment of congenital cardiac defects in the pediatric population.","volume":"82","author":"Lavoie","year":"1996","journal-title":"Anesth Analg"},{"issue":"3","key":"2021121107053850300_B33","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/0003-4975(95)01153-6","article-title":"Coarctation repair using end-to-side anastomosis of descending aorta to proximal aortic arch.","volume":"61","author":"Rajasinghe","year":"1996","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"2021121107053850300_B34","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/0003-4975(95)01152-8","article-title":"Incidence of vocal fold paralysis in infants undergoing ligation of patent ductus arteriosus.","volume":"61","author":"Zbar","year":"1996","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"2021121107053850300_B35","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1016\/S0022-5223(95)70031-5","article-title":"Video-assisted thoracoscopic surgical interruption: the technique of choice for patent ductus arteriosus. Routine experience in 230 pediatric cases.","volume":"110","author":"Laborde","year":"1995","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"4","key":"2021121107053850300_B36","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S0022-5223(19)34364-8","article-title":"Paralyzed left vocal cord associated with ligation of patent ductus arteriosus.","volume":"98","author":"Fan","year":"1989","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"2","key":"2021121107053850300_B37","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/S0003-4975(10)65901-2","article-title":"Vocal cord paralysis in premature infants undergoing ductal closure.","volume":"46","author":"Davis","year":"1988","journal-title":"Ann Thorac Surg"},{"key":"2021121107053850300_B38","first-page":"848","article-title":"Treatment of vocal fold paralysis","volume-title":"Otolaryngology Head & Neck Surgery","author":"Simpson","year":"2006","edition":"4th ed."},{"issue":"12","key":"2021121107053850300_B39","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1001\/archoto.2011.184","article-title":"Intraoperative laryngeal electromyography in children with vocal fold immobility: results of a multicenter longitudinal study.","volume":"137","author":"Maturo","year":"2011","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"9","key":"2021121107053850300_B40","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1016\/j.ijporl.2011.06.017","article-title":"Value of ultrasonography in diagnosis of pediatric vocal fold paralysis.","volume":"75","author":"Wang","year":"2011","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"5","key":"2021121107053850300_B41","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.otohns.2007.07.028","article-title":"Pediatric vocal fold paralysis after cardiac surgery: rate of recovery and sequelae.","volume":"137","author":"Truong","year":"2007","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"3","key":"2021121107053850300_B42","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1001\/archoto.2011.24","article-title":"Injection medialization laryngoplasty in children.","volume":"137","author":"Cohen","year":"2011","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"2021121107053850300_B43","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1002\/lary.23815","article-title":"Recurrent laryngeal nerve reinnervation for unilateral vocal fold immobility in children.","volume":"122","author":"Zur","year":"2012","journal-title":"Laryngoscope"},{"issue":"10","key":"2021121107053850300_B44","doi-asserted-by":"crossref","first-page":"2172","DOI":"10.1002\/lary.21754","article-title":"Medialization versus reinnervation for unilateral vocal fold paralysis: a multicenter randomized clinical trial.","volume":"121","author":"Paniello","year":"2011","journal-title":"Laryngoscope"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/133\/6\/e1708\/923147\/peds_2013-3939.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/133\/6\/e1708\/923147\/peds_2013-3939.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T09:12:27Z","timestamp":1639213947000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/133\/6\/e1708\/76054\/Unilateral-Vocal-Fold-Paralysis-After-Congenital"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,6,1]]},"references-count":44,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2014,6,1]]},"published-print":{"date-parts":[[2014,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2013-3939","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,6,1]]}}}