Adamovich-Rippe Krista N, Steffey Michele A, Ybarra Winnie L, Johnson Lynelle R
Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA.
J Am Vet Med Assoc. 2013 Jun 15;242(12):1727-31. doi: 10.2460/javma.242.12.1727.
An 8-week-old female domestic shorthair cat was treated for patent ductus arteriosus (PDA) with surgical ligation. Seven weeks postoperatively, the cat was evaluated because of increased upper respiratory noise, inspiratory stridor, wheezing, and episodes of intermittent open-mouth breathing that had developed 1 week following the surgical ligation.
The cat was sedated, and examination of the larynx revealed left-sided laryngeal paralysis.
At the time left-sided laryngeal paralysis was diagnosed, the clinical signs of laryngeal dysfunction were not considered severe enough to warrant surgical intervention. No treatment was administered, and the owner monitored the cat for respiratory distress and worsening of clinical signs for an additional 5 months. During those 5 months, the clinical signs improved but persisted. Seven months after PDA ligation, the cat was again sedated and the larynx examined. The examination revealed persistent left arytenoid dysfunction, which was believed to be the result of permanent damage to the recurrent laryngeal nerve that was sustained during the surgical ligation of the PDA. The owner was counseled about surgical and medical treatment options for laryngeal paralysis but elected to forego treatment at that time.
Unilateral laryngeal paralysis caused by iatrogenic damage to the recurrent laryngeal nerve is a potential complication subsequent to surgical ligation of a PDA. The frequency of iatrogenically induced laryngeal paralysis is likely underestimated in small animal patients. Laryngoscopy should be performed in any small animal with a history of PDA attenuation and clinical signs of respiratory tract disease.
一只8周龄的雌性家猫因动脉导管未闭（PDA）接受了手术结扎治疗。术后7周，这只猫因手术结扎1周后出现的上呼吸道噪音增加、吸气性喘鸣、喘息以及间歇性张口呼吸发作而接受评估。
对这只猫进行了镇静处理，喉部检查显示左侧喉麻痹。
在诊断出左侧喉麻痹时，喉部功能障碍的临床症状被认为不够严重，无需进行手术干预。未给予任何治疗，主人对这只猫进行了另外5个月的呼吸窘迫和临床症状恶化监测。在这5个月期间，临床症状有所改善但仍持续存在。PDA结扎术后7个月，再次对这只猫进行镇静并检查喉部。检查发现左侧杓状软骨功能持续存在障碍，这被认为是PDA手术结扎过程中喉返神经受到永久性损伤的结果。已向主人咨询了喉麻痹的手术和药物治疗方案，但主人当时选择放弃治疗。
PDA手术结扎后，喉返神经医源性损伤导致的单侧喉麻痹是一种潜在并发症。在小动物患者中，医源性诱发喉麻痹的发生率可能被低估。对于有PDA治疗史且出现呼吸道疾病临床症状的任何小动物，都应进行喉镜检查。
