Hoarseness after pulmonary arterial stenting and occlusion of the arterial duct

Abstract

We report a 12-year-old girl who had multiple congenital cardiac lesions, specifically an arterial duct, left pulmonary arterial stenosis, an atrial septal defect in the oval fossa, and mild Ebstein's malformation of the tricuspid valve. Therapeutic transcatheter intervention was performed to stent the left pulmonary artery, occlude the arterial duct with a coil, and place a device to close the atrial septal defect. Subsequent to the catheterization, she complained of hoarseness, which was shown to be due to entrapment of the left recurrent laryngeal nerve between the coil used to close the arterial duct and the stent placed in the left pulmonary artery. Laryngoscopy confirmed paralysis of the recurrent laryngeal nerve.

Vocal cord paralysis after transcatheter patent ductus arteriosus closure with Amplatzer Vascular Plug-2

“…This condition suggests us that LRLN paralysis may have been caused by the device. This is similar to the case reported by Assaqqat et al (6) wherein LRLN was compressed between the LPA stent and the PDA coil.…”

“…Cardiovascular conditions leading to Ortner’s syndrome are aortic diseases; left atrial disorders; and congenital heart diseases, including atrial septal defect, ventricular septal defect, total anomalous pulmonary venous connection, PDA, double outlet right ventricle, left main coronary artery arising from the pulmonary artery, and idiopathic pulmonary hypertension (2). It has also been reported that cardiovascular interventions cause iatrogenic Ortner’s syndrome were coil closure of PDA, endoluminal treatment of a thoracic aortic aneurysm, transcatheter ablation of atrial fibrillation, and stenting of the left pulmonary artery (1-6).…”

Cardiovocal syndrome after transradial cardiac catheterization: An unusual complication

“…Similar complications have also been described during percutaneous interventional procedures, such as transvenous insertion of a permanent endocardial pacemaker [5], transcatheter ablation of atrial fibrillation [6], stenting of the left pulmonary artery [7] and coil closure of patent ductus arteriosus (PDA) [7][8][9] with analogous pathogenetic mechanisms. Particularly, in the PDA closure cases, an oversized or inappropriate coil implantation, by distorting the slender PDA, caused the angulation of the pliable PDA itself and precipitated the impingement on the left RLN.…”

Vocal Cord Palsy after Left Pulmonary Artery Stent Insertion

“…Because there have been only two cases of LRLNP after LPA stent insertion, 1 2 the risk factors are unknown. Tetralogy of Fallot (TOF) frequently accompanies LPA stenosis and vice versa.…”

“…Assaqqat et al 1 reported LRLNP after a concurrent intervention on the LPA, PDA and ASD. They assumed that the LRLN might have been entrapped between the two devices in the PDA and LPA.…”