@Article{chd.12456,
AUTHOR = {Katlyn Elizabeth McGrattan, Heather McGhee, Allan DeToma, Elizabeth G. Hill, Sinai C. Zyblewski, Maureen Lefton-Greif, Lucinda Halstead, Scott M. Bradley, Bonnie Martin-Harris},
TITLE = {Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {12},
YEAR = {2017},
NUMBER = {3},
PAGES = {382--388},
URL = {http://www.techscience.com/schd/v12n3/39124},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> 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.<br/>
<b>Objective:</b> Identify the physiologic correlates of dysphagia in infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliative surgery.<br/>
<b>Methods:</b> 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.<br/>
<b>Results:</b> 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.<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12456}
}