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AJR 2003; 180:987-992
© American Roentgen Ray Society

Videofluoroscopy of Swallowing Abnormalities in 22 Symptomatic Patients After Cardiovascular Surgery

Bernhard L. Partik1, Martina Scharitzer1, Gerd Schueller1, Martin Voracek2, Wolfgang Schima1, Ewald Schober1, Michael R. Mueller3, Ann N. Leung1, Doris-Maria Denk4 and Peter Pokieser1

1 Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
2 Department of Psychoanalysis and Psychotherapy, Documentation and Statistics Branch, University of Vienna, A-1090 Vienna, Austria.
3 Department of Thoracic and Cardiovascular Surgery, University of Vienna, A-1090 Vienna, Austria.
4 Department of Otolaryngology, University of Vienna, A-1090 Vienna, Austria.

OBJECTIVE. The aim of this study was to evaluate the types of swallowing abnormalities that occur in symptomatic patients who have undergone cardiovascular surgery.

MATERIALS AND METHODS. From 1994 to 2001, 22 patients (17 males and five females; age range, 4–89 years; mean age, 64 years) who had swallowing abnormalities after cardiovascular surgery were referred for a videofluoroscopic swallowing study. Each study was analyzed for functional abnormalities of the tongue, soft palate, epiglottis, hyoid and larynx, pharynx, upper esophageal sphincter, and esophagus. Also, the performance of transesophageal echocardiography, long-term intubation, or both was noted.

RESULTS. Swallowing abnormalities were present in 18 patients (81.8%) (range, one to eight functional abnormalities; mean, 3.9 functional abnormalities). The distribution of abnormalities across the functional units statistically significantly deviated ({chi}2 = 14.4; df = 6; p = 0.025) from uniform distribution, with abnormalities most commonly involving the hyoid and larynx (13 patients [59.1%]) and the pharynx (10 patients [45.5%]). Aspiration was found in 13 patients (59.1%) (predeglutitive, n = 1; intradeglutitive, n = 4; postdeglutitive, n = 3; and mixed, n = 5). In the 14 patients (63.6%) who underwent transesophageal echocardiography, long-term intubation, or both, we frequently found incomplete tilting of the epiglottis, pharyngeal weakness, and postdeglutitive aspiration.

CONCLUSION. Most patients with swallowing problems after cardiovascular surgery present with multiple abnormalities that most commonly affect the hyoid and larynx and the pharynx and result predominantly in intra- or postdeglutitive aspiration. The performance of transesophageal echocardiography and long-term intubation may influence the types of swallowing abnormalities.


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