During patent ductus arteriosus repair, which nerve is at risk?

• A. Vagus nerve
• B. Phrenic nerve
• C. Right recurrent laryngeal nerve
• D. Left recurrent laryngeal nerve

Answer: (D)

Left recurrent laryngeal nerve is at risk during patent ductus arteriosus repair. It loops under the aortic arch and ascends in the tracheoesophageal groove to reach the larynx. The ductus arteriosus sits near the ligamentum arteriosum on the inferior surface of the aorta, so surgical ligation in this region can injure the left RLN. Damage leads to hoarseness from paralysis of the left vocal cord. The right recurrent laryngeal nerve is higher up around the right subclavian artery and is not in the operative field for this procedure, making it less susceptible. The phrenic nerve lies anterior to the root of the lung and isn’t typically involved in PDA repair.