Which nerve is at risk when repairing a patent ductus arteriosus?

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

Answer: (D)

During a patent ductus arteriosus repair, the left recurrent laryngeal nerve is particularly at risk because its path closely surrounds the aortic arch near the ligamentum arteriosum, the fibrous remnant of the ductus arteriosus. After looping under the arch, the left recurrent laryngeal nerve ascends in the tracheoesophageal groove to the larynx to innervate the vocal folds. Injury to this nerve can lead to hoarseness from vocal cord paralysis. The right recurrent laryngeal nerve, which loops under the right subclavian artery, travels higher up and away from the PDA region, making it less susceptible. While the vagus and phrenic nerves are in the mediastinum, the most specific and well-known risk in this surgery is injury to the left recurrent laryngeal nerve due to its intimate relationship with the aortic arch and ligamentum arteriosum.