What is the most likely cause of new-onset stridor and hoarseness in a patient after PDA closure?

The presence of new-onset stridor and hoarseness following patent ductus arteriosus (PDA) closure is most likely attributed to surgical dissection causing recurrent laryngeal nerve injury. The recurrent laryngeal nerve is crucial for innervating the vocal cords and maintaining normal phonation and airway protection. During surgical procedures around the heart, especially in the thoracic region, there is a risk of damaging this nerve due to its anatomical proximity to the surgical site.

When the recurrent laryngeal nerve gets injured, it can lead to vocal cord paralysis or dysfunction, resulting in stridor (a high-pitched wheezing sound due to narrowed airways) and hoarseness (changes in voice). This scenario is particularly relevant in the context of PDA closure, as the surgical approach may involve manipulating structures near the aorta where the recurrent laryngeal nerve runs.

Other choices, while they could potentially lead to airway complications, do not explain the specific combination of stridor and hoarseness as clearly as recurrent laryngeal nerve injury. For instance, an incorrectly sized endotracheal tube could cause airway obstruction but typically would not result in hoarseness unless there was significant trauma to the vocal cords