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Atrial Septal Defect and Left Recurrent Laryngeal Nerve Paralysis: A Case of Ortner’s Syndrome and Literature Review

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DOI: 10.4236/ijohns.2015.42011    2,567 Downloads   3,004 Views  

ABSTRACT

Introduction: Cardiovocal syndrome, or hoarseness resulting from vocal fold paralysis secondary to cardiovascular pathology, is commonly referred to as Ortner’s syndrome. We present a brief overview of vocal fold paralysis, present an illustrative case of Ortner’s syndrome, and provide a review of the pertinent literature. Here we aim to broaden one’s differential for vocal fold paralysis, discuss its importance as pertains to cardiovascular pathology and outcomes, and highlight the difficulties in therapeutic planning for these unique patients. Methods: A case report and literature review. Results: A 26-year-old female with an atrial septal defect and pulmonary hypertension presented with 5 months of hoarseness. Laryngoscopy revealed left vocal fold paralysis. Imaging from the skull base to chest showed an enlarged pulmonary artery (PA) in the absence of other abnormalities. Literature review suggests that this left laryngeal nerve paralysis results from nerve compression within the aortopulmonary window, a triangle defined by the aortic arch, PA, and ligamentumarteriosum. Imaging in our patient over 8 months demonstrated an increase in PA size from 3.9 to 4.2 cm correlating with the onset of hoarseness. Conclusions: Importantly, hoarseness second ary to laryngeal nerve compression in cardiovascular disease may correlate with a poorer prognosis, i.e., in thoracic aortic aneurysms and mitral valvestenosis. Awareness of vocal changes in the setting of cardiovascular disease improves diagnostic acumen in vocal foldparalysis.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Vahabzadeh-Hagh, A. , Yim, C. , Fitter, J. and Chhetri, D. (2015) Atrial Septal Defect and Left Recurrent Laryngeal Nerve Paralysis: A Case of Ortner’s Syndrome and Literature Review. International Journal of Otolaryngology and Head & Neck Surgery, 4, 61-65. doi: 10.4236/ijohns.2015.42011.

References

[1] Misono, S. andMerati, A.L. (2012) Evidence-Based Practice: Evaluation and Management of Unilateral Vocal Fold Paralysis. Otolaryngologic Clinics of North America, 45, 1083-1108.
http://dx.doi.org/10.1016/j.otc.2012.06.011
[2] Ortner, N. (1897) Recurrent Nerve Palsy in Patient with Mitral Stenosis (German). Wiener KlinischeWochenschrift, 10, 753-755.
[3] Nakao, M., Sawayama, T., Samukawa, M., et al. (1985) Left Recurrent Laryngeal Nerve Palsy Associated with Primary Pulmonary Hypertension and Patent DuctusArteriosus. Journal of the American College of Cardiology, 5, 788-792.
http://dx.doi.org/10.1016/S0735-1097(85)80413-7
[4] Paquette, C.M., Manos, D.C. andPsooy, B.J. (2012) Unilateral Vocal Cord Paralysis: A Review of CT Findings, Mediastinal Causes, and the Course of the Recurrent Laryngeal Nerves. Radiographics, 32, 721-740.
http://dx.doi.org/10.1148/rg.323115129
[5] Mulpuru, S.K., Vasavada, B.C., Punukollu, G.K. and Patel, A.G. (2008) CardiovocalSyndrome: A Systematic Review. Heart, Lung and Circulation, 17, 1-4.
http://dx.doi.org/10.1016/j.hlc.2007.04.007
[6] Ishii, K., Adachi, H., Tsubaki, K., Ohta, Y., Yamamoto, M. andIno, T. (2004) Evaluation of Recurrent Nerve Paralysis Due to Thoracic Aortic Aneurysm and Aneurysm Repair. Laryngoscope, 114, 2176-2181.
http://dx.doi.org/10.1097/01.mlg.0000149453.91005.ab
[7] Plastiras, S.C., Pamboucas, C., Zafiriou, T., Lazaris, N. andToumanidis, S. (2010) Ortner’sSyndrome: A Multifactorial Cardiovocal Syndrome. Clinical Cardiology, 33, E99-E100.
http://dx.doi.org/10.1002/clc.20646
[8] Subramaniam, V., Herle, A., Mohammed, N. andThahir, M. (2011) Ortner’sSyndrome: Case Series and Literature Review. Brazilian Journal of Otorhinolaryngology, 77, 559-562.
http://dx.doi.org/10.1590/S1808-86942011000500004
[9] Morales, J.P., Chan, Y.C., Bell, R.E., Reidy, J.F. and Taylor, P.R. (2008) EndoluminalRepair of Distal Aortic Arch Aneurysms Causing Aorto-Vocal Syndrome. International Journal of Clinical Practice, 62, 1511-1514.
http://dx.doi.org/10.1111/j.1742-1241.2006.01282.x
[10] Fennessy, B.G., Sheahan, P. andMcShane, D. (2008) Cardiovascular Hoarseness: An Unusual Presentation to Otolaryngologists. Journal of Laryngology and Otology, 122, 327-328.
http://dx.doi.org/10.1017/S0022215107008110
[11] Dolowitz, D.A. and Lewis, C.S. (1948) Left Vocal Cord Paralysis Associated with Cardiac Disease. American Journal of Medicine, 4, 856-862.
http://dx.doi.org/10.1016/0002-9343(48)90482-3

  
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