Dysphonia: A frequently encountered symptom in the evaluation of infants with unobstructed supracardiac total anomalous pulmonary venous connection

Total anomalous pulmonary venous connection is a relatively uncommon congen ital cardiac anomaly. When there is obstruction to pulmonary venous drainag e or severe pulmonary hypertension due to increased pulmonary blood flow, t he patient is usually critically ill and the diagnosis is unambiguous. Howe ver, in some patients the symptoms may be mild and often overlap with those of other noncardiac diseases. Tachypnea, failure to thrive, and mild cyano sis are the most frequently reported symptoms. In our patient population, w e encountered a frequent observation by parents that the child had an alter ation in voice which we elected to refer to as dysphonia for the purpose of this study. We retrospectively reviewed all patients with total anomalous pulmonary venous connection who were evaluated at our institution from Janu ary 1996 to January 1999 and found that 27% of patients had dysphonia as a presenting complaint to their primary care provider. We hypothesize that th e etiology of this phenomenon lies in the possible compression of the left recurrent laryngeal nerve in the vicinity of the dilated pulmonary artery a nd the left vertical vein.