Vocal fold paralysis in painless aortic dissection (Ortner's syndrome). (Imaging Clinic).Cardiovocal syndrome was first described a century ago by Ortner. He attributed a case of left vocal fold immobility to compression of the recurrent laryngeal nerve recurrent laryngeal nerve n. A branch of the vagus nerve that supplies the cardiac, tracheal and esophageal branches and terminates as the inferior laryngeal nerve. by a dilated left atrium in a patient with mitral valve stenosis Mitral Valve Stenosis Definition The term stenosis means an abnormal narrowing of an opening. Mitral valve stenosis refers to a condition in the heart in which one of the valve openings has become narrow and restricts the flow of blood from the upper . Since then, the term Ortner's syndrome has come to encompass any nonmalignant, cardiac, intrathoracic process that results in embarrassment of either recurrent laryngeal nerve--usually by stretching, pulling, or compression--and causes a vocal fold paralysis. Not surprisingly, the left recurrent laryngeal nerve, with its longer course around the aortic arch, is more frequently involved than is the right nerve, which passes around the subclavian artery. Causes of Ortner's syndrome that have been described in the literature include atrial septal defect Atrial Septal Defect Definition An atrial septal defect is an abnormal opening in the wall separating the left and right upper chambers (atria) of the heart. , Eisenmenger's complex, patent ductus arteriosus Patent Ductus Arteriosus Definition Patent ductus arteriosus (PDA) is a heart defect that occurs when the ductus arteriosus (the temporary fetal blood vessel that connects the aorta and the pulmonary artery) does not close at birth. , primary pulmonary hypertension, and aortic aneurysm. A 79-year-old man had his vocal fold mobility documented as normal at a major university center following the latest of his two coronary artery bypass graft surgeries in 1998. He returned 2 years later complaining of hoarseness, but no other symptoms. His dysphonia dysphonia /dys·pho·nia/ (-fo´ne-ah) a voice impairment or speech disorder.dysphon´ic dys·pho·ni·a n. Difficulty in speaking, usually evidenced by hoarseness. , which had resolved after each of his previous two operations, had returned. On physical examination, a left vocal fold paralysis was observed. Computed tomography (CT) of the chest revealed a dissecting aortic aneurysm dissecting aortic aneurysm Cardiovascular disease An aneurysm of the aorta in which there is an internal split in the wall of the aorta, caused by either ASHD or cystic medial hyperplasia. See Aneurysm, Aortic aneurysm. (figure), which suggested a recurrent laryngeal nerve injury that was caused by the stretching of the nerve around a slowly expanding aortic arch. This was a chronic and painless disease process. The patient was referred to a cardiologist, who prescribed treatment based on the chronic nature of his condition and the patient's overall health. Suggested Reading Khan IA, Wattanasauwan N, Ansari AW. Painless aortic dissection presenting as hoarseness of voice: Cardiovocal syndrome: Ortner's syndrome. Am J Emerg Med 1999;17:361-3. Kishan CV, Wongpraparut N, Adeleke K, et al. Ortner's syndrome in association with mitral valve prolapse Mitral Valve Prolapse Definition Mitral valve prolapse (MVP) is a ballooning of the support structures of the mitral heart valve into the left upper collection chamber of the heart. . Clin Cardiol 2000;23:295-7. Thirlwall AS. Ortner's syndrome: A centenary review of unilateral recurrent laryngeal nerve palsy secondary to cardiothoracic disease. J Laryngol Otol 1997;111:869-71. |
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