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Anesthesia

Swallowing problems after heart surgery

02/21/2006

Question:

My 82 year old Aunt had triple by pass surgery second week in December. Very active prior to surgery. After surgery has had problems with swallowing. They put her on a feeding tube. Had barrium swallow test and the ENT told her it was due to moisture on left vocal chord from eating/drinking going into her lungs. Speech is normal. Mobility is normal. She has a rehab speech therapist. Had MRI - no stroke. Do you have info on this? Thank you.

Answer:

Problems with swallowing occur in 3-4% of patients who have had heart surgery. Quite often no specific cause is found. Patients with diabetes, heart failure, or poor kidney function before their surgery are more likely to develop this problem.

Subtle neurologic problems are surprisingly common after heart surgery, this is thought to have something to do with the use of the heart-lung (bypass) machine. So problems swallowing (“dysphagia”) may actually result from a minor brain injury that does not show up on MRI. Having a breathing tube (endotracheal tube) in place for a long time after the surgery may also contribute.

It is important to recognize swallowing problems early because patients who cannot swallow properly are prone to aspiration, that is the passage of food content into the lungs. This leads to pneumonia which can be very serious or even fatal.

The appropriate treatment is speech therapy and the insertion of a feeding tube. Most patients will recover their ability to swallow but it may take as long as 6 months.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University