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ARTICLE

Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment

Katlyn Elizabeth McGrattan^1,2,3,4, Heather McGhee^2,3, Allan DeToma⁵, Elizabeth G. Hill⁵, Sinai C. Zyblewski⁶, Maureen Lefton-Greif^7,8,9, Lucinda Halstead^1,2, Scott M. Bradley¹⁰, Bonnie Martin-Harris^1,2,3,4

1 Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
2 Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina
3 Department of Speech Language Pathology, Medical University of South Carolina, Charleston, South Carolina
4 Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina
5 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
6 Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
7 Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
8 Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
9 Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland
10 Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina

* Corresponding Author: Katlyn Elizabeth McGrattan, Northwestern University, 2240 Campus Drive, Evanston, IL 60208. Email:

Congenital Heart Disease 2017, 12(3), 382-388. https://doi.org/10.1111/chd.12456

Abstract

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.

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