Korean Circ J.  2012 Jul;42(7):507-510. 10.4070/kcj.2012.42.7.507.

Ortner Syndrome due to Concomitant Mitral Stenosis and Bronchiectasis

• Islam AM
• Zaman S
• Doza F

• KMID: 2094126
• DOI: http://doi.org/10.4070/kcj.2012.42.7.507

Abstract

Ortner syndrome or cardiovocal syndrome is a rare condition characterized by hoarseness of voice associated with cardiovascular pathology. Compression of the left recurrent laryngeal nerve by the pulmonary artery or left atrium is usually responsible. Recurrent aspiration pneumonia may cause significant morbidity and mortality. Early recognition and treatment along with removal of the underlying cause, if possible, may change an otherwise poor prognosis of the condition. The case presented here describes a 35-year old female with hoarseness of voice in association with mitral stenosis and bronchiectasis. Presence of dual pathology contributed to the overall pathophysiology of the disease, and made its management difficult.

Keyword

Mitral stenosis; Recurrent laryngeal nerve; Bronchiectasis

MeSH Terms

Bronchiectasis
Female
Heart Atria
Hoarseness
Humans
Mitral Valve Stenosis
Pneumonia, Aspiration
Prognosis
Pulmonary Artery
Recurrent Laryngeal Nerve

Figure

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  Fig. 1 Radiologic findings of chest X-ray. A: postero-anterior view shows multiple ring shadows through the cardiac silhouette. B: left lateral view shows reduction of retrosternal and retrocardiac spaces and multiple ring shadows through the cardiac silhouette.

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  Fig. 2 High resolution CT scan of chest, lung window setting shows multiple cystic air spaces larger than the corresponding vessels in all segments of both lungs.

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  Fig. 3 CT pulmonary angiogram. A: coronal view shows CT pulmonary angiogram, coronal view shows the dilated pulmonary trunk. B: axial view shows CT pulmonary angiogram shows dilated pulmonary trunk and its branches; pulmonary trunk 34 mm, right pulmonary artery 23.8 mm and the left pulmonary artery 18.7 mm.

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  Fig. 4 Direct laryngoscopy shows left vocal cord palsy.

Reference

1. Ortner N. Recurrent laryngeal nerve paralysis due to mitral valve stenosis. Wien Klin Wochenschr. 1897. 10:753–755.

2. Plastiras SC, Pamboucas C, Zafiriou T, Lazaris N, Toumanidis S. Ortner's syndrome: a multifactorial cardiovocal syndrome. Clin Cardiol. 2010. 33:E99–E100.

3. Prada-Delgado O, Barge-Caballero E. Images in clinical medicine: Ortner's syndrome. N Engl J Med. 2011. 365:939.

4. Gulel O, Koprulu D, Kucuksu Z, Yazici M, Cengel S. Images in cardiovascular medicine: cardiovocal syndrome associated with huge left atrium. Circulation. 2007. 115:e318–e319.

5. Rubens F, Goldstein W, Hickey N, Dennie C, Keon W. Hoarseness secondary to left atrial myxoma. Chest. 1989. 95:1139–1140.

6. Kagal AE, Shenoy PN, Nair KG. Ortner's syndrome associated with primary pulmonary hypertension. J Postgrad Med. 1975. 21:91–95.

7. Nakao M, Sawayama T, Samukawa M, et al. Left recurrent laryngeal nerve palsy associated with primary pulmonary hypertension and patent ductus arteriosus. J Am Coll Cardiol. 1985. 5:788–792.

8. Ishimoto S, Ito K, Toyama M, et al. Vocal cord paralysis after surgery for thoracic aortic aneurysm. Chest. 2002. 121:1911–1915.

9. Escribano JF, Carnés J, Crespo MA, Antón RF. Ortner's syndrome and endoluminal treatment of a thoracic aortic aneurysm: a case report. Vasc Endovascular Surg. 2006. 40:75–78.

10. Lee SI, Pyun SB, Jang DH. Dysphagia and hoarseness associated with painless aortic dissection: a rare case of cardiovocal syndrome. Dysphagia. 2006. 21:129–132.

11. Albertini RE. Vocal cord paralysis associated with pulmonary emboli. Chest. 1972. 62:508–510.

12. Victoria L, Graham SM, Karnell MP, Hoffman HT. Vocal fold paralysis secondary to cardiac countershock (cardioversion). J Voice. 1999. 13:414–416.

13. Pai RK, Boyle NG, Child JS, Shivkumar K. Transient left recurrent laryngeal nerve palsy following catheter ablation of atrial fibrillation. Heart Rhythm. 2005. 2:182–184.

14. Tewari P, Aggarwal SK. Combined left-sided recurrent laryngeal and phrenic nerve palsy after coronary artery operation. Ann Thorac Surg. 1996. 61:1721–1722.

15. Murty GE, Smith MC. Recurrent laryngeal nerve palsy following heart-lung transplantation: three cases of vocal cord augmentation in the acute phase. J Laryngol Otol. 1989. 103:968–969.

16. Solanki SV, Yajnik VH. Ortner's syndrome. Indian Heart J. 1972. 24:43–46.

17. Meyer E, Jonas NE, Zühlke LJ. Ortner syndrome. S Afr J Child Health. 2008. 2:170–171.

18. Ishii K, Adachi H, Tsubaki K, Ohta Y, Yamamoto M, Ino T. Evaluation of recurrent nerve paralysis due to thoracic aortic aneurysm and aneurysm repair. Laryngoscope. 2004. 114:2176–2181.

19. Mulpuru SK, Vasavada BC, Punukollu GK, Patel AG. Cardiovocal syndrome: a systematic review. Heart Lung Circ. 2008. 17:1–4.

20. Hartl DM, Travagli JP, Leboulleux S, Baudin E, Brasnu DF, Schlumberger M. Clinical review: current concepts in the management of unilateral recurrent laryngeal nerve paralysis after thyroid surgery. J Clin Endocrinol Metab. 2005. 90:3084–3088.