TITLE:
Atrial Septal Defect and Left Recurrent Laryngeal Nerve Paralysis: A Case of Ortner’s Syndrome and Literature Review
AUTHORS:
Andrew M. Vahabzadeh-Hagh, Catherine Yim, Jayson Fitter, Dinesh K. Chhetri
KEYWORDS:
Ortner’s, Cardiovocal, Vocalfoldparalysis
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.4 No.2,
February
26,
2015
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.