Abstract
Objective: Evaluate the need for gastrostomy and fundoplication in neonates following aortic arch surgery.
Method: Sixty neonates from 2007 to 2010 who underwent the Norwood procedure, aortic arch augmentation and reconstruction, or coarctation repair were reviewed retrospectively. Results of modified barium swallow (MBS), laryngoscopy, upper GI series (UGI), and 24-hour pH probe were reviewed for patients who underwent gastrostomy tube placement with or without fundoplication.
Results: After aortic arch procedures, 32 neonates (53.3%) underwent gastrostomy tubes (GT); an additional 26 (43.3%) patients also underwent concomitant fundoplication. Of those with unilateral vocal fold immobility, 50% (8 out of 16) aspirated on MBS, 10 out of 18 (55.6%) revealed reflux on UGI, but only 2 out of 9 (22.2%) had abnormal pH studies. Of those with normal vocal fold mobility, 88.9% (8 out of 9) patients demonstrated aspiration on MBS, 9 out of 12 (75%) showed reflux on UGI with one malrotation discovered, and 2 out of 5 (40%) patients had abnormal pH probe studies.
Conclusion: Neonates who undergo aortic arch procedures are at high risk of aspiration and other swallowing abnormalities. In this study, over half underwent GTs and many also required fundoplication, although results of pH probe studies seem to be inconsistent and limited, and therefore, its clinical usefulness is questionable for this patient population.
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