Neuro-motor mechanisms of Pharyngo-esophageal Motility in Dysphagic Infants with Congenital Heart Disease

INTRODUCTION: Aero-digestive morbidities are common in congenital heart disease infants and mechanisms are unclear. We hypothesized that adaptive pharyngo-esophageal motility reflexes are different in surgical congenital heart disease infants (S-CHD) vs. nonsurgical congenital heart disease infants (CHD) and healthy controls. METHODS: Abrupt pharyngeal provocation was performed with graded water infusions using purpose-built micro-manometry. Data from 12 S-CHD were compared with 10 CHD and 12 controls. 197 water stimulations were examined for the frequency, latency, duration and magnitude of Pharyngo-Upper Esophageal Sphincter contractile response (PUCR), Pharyngeal reflexive swallow (PRS), esophageal body peristalsis and lower esophageal sphincter (LES) relaxation characteristics. Mixed statistical models were applied. RESULTS: Frequency distribution (%) of PUCR: PRS: None in S-CHD vs. CHD vs. controls respectively were 36:46:17 vs. 9:80:11 vs. 15:61:24 (p < 0.05). Response latency to the final esophageal body waveform (p = 0.01) and the response duration of esophageal body peristalsis (p = 0.04) were prolonged in S-CHD vs. controls but were similar to CHD (p = 0.22). Pharyngeal infusion induced LES relaxation characteristics were similar in all 3 groups. CONCLUSIONS: Abnormality in the recruitment of PUCR or PRS reflexes and esophageal body peristalsis in S-CHD implicate dysregulation in vagal cholinergic excitatory neuromotor responses.