Background: Deficits in swallowing physiology are a leading morbidity for infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliation. Despite the high prevalence of this condition, the underlying deficits that cause this post-operative impairment remain poorly understood. Objective: Identify the physiologic correlates of dysphagia in infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliative surgery. Methods: Postoperative fiberoptic laryngoscopies and videofluoroscopic swallow studies (VFSS) were conducted sequentially on infants with functional single ventricles following stage 1 palliative surgery. Infants were dichotomized as having normal or impaired laryngeal function based on laryngoscopy findings. VFSS were evaluated frame-by-frame using a scale that quantifies performance within 11 components of swallowing physiology. Physiologic attributes within each component were categorized as high functioning or low functioning based on their ability to support milk ingestion without bolus airway entry. Results: Thirty-six infants (25 male) were included in the investigation. Twenty-four underwent the Norwood procedure and twelve underwent the Hybrid procedure. Low function physiologic patterns were observed within multiple swallowing components during the ingestion of thin barium as characterized by ≥4 sucks per swallow (36%), initiation of pharyngeal swallow below the level of the valleculae (83%), and incomplete late laryngeal vestibular closure (56%) at the height of the swallow. Swallowing deficits contributed to aspiration in 50% of infants. Although nectar thick liquids reduced the rate of aspiration (P =.006), aspiration rates remained high (27%). No differences in rates of penetration or aspiration were observed between infants with normal and impaired laryngeal function. Conclusions: Deficits in swallowing physiology contribute to penetration and aspiration following stage 1 palliation among infants with normal and impaired laryngeal function. Although thickened liquids may improve airway protection for select infants, they may inhibit their ability to extract the bolus and meet nutritional needs.
Bibliographical noteFunding Information:
The authors would like to thank the faculty and staff within the Medical University of South Carolina Department of Radiology for making this work possible. Study design was completed by Dr. McGrattan, Dr. Martin-Harris, Dr. Lefton-Greif, Dr. Zyblewski, and Dr. Bradley. Development of the VFSS evaluation tool was completed by Dr. Martin-Harris and Dr. Lefton-Greif. Videofluoroscopic and endoscopic data collection was completed by Dr. McGrattan, Heather McGhee, and Dr. Halstead. Collection of cardiothoracic and medical data was performed by Dr. Zyblewski. Videofluoroscopic data analysis was completed by Dr. McGrattan and Heather McGhee. Statistical Analysis was completed by Allan DeToma and Dr. Hill. All authors were involved in the preparation of the manuscript and provided final review prior to submission.
- hypoplastic left heart syndrome
- single ventricle
- stage 1 palliation