Hoarseness Due to Aortic Arch Aneurysms

Abstract

Objective To give an overview of the Ortner’s syndrome caused by an aortic arch aneurysm. Methods By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own. Results The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients. Conclusion The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.

Clinical Outcomes of Surgical Unroofing of Myocardial Bridging in Symptomatic Patients

“…12,14 Calcium channel blockers can also alleviate coronary spasm in the bridged segment. 4 In our study most patients continued taking medications after their operations and required frequent changes in their regimens. Intracoronary stenting has been used as a treatment option for medically refractory patients, but rates of in-stent stenosis requiring subsequent revascularization are high, ranging from 19% to 24% for drug-eluting stents to 36% for bare metal stents.…”

“…3 The tunneled segment is often associated with endothelial dysfunction and may have a variety of clinical manifestations. 4,5 Some patients with myocardial bridging are asymptomatic, whereas others present with ischemic symptoms including angina, myocardial infarction, or sudden death. 1,6 There has been debate regarding the clinical significance of myocardial bridging and the link between the mechanism of pathophysiology and symptoms.…”

Disfonía como manifestación de fuga endoprotésica de aneurisma de aorta: Un caso de síndrome de Ortner

“…Para el diagnóstico de síndrome de Ortner es importante realizar una laringoscopia para ver la posición de la cuerda vocal y la presencia de lesiones intrínsecas, además se debe obtener un estudio de imagen donde se pueda apreciar todo el recorrido del nervio para ubicar el sitio de lesión. 27 Dentro de los hallazgos de parálisis cordal en tomografía de corte axial tenemos la dilatación del seno piriforme ipsilateral, rotación medial y engrosamiento del pliegue aritenoepiglótico, dilatación del ventrículo laríngeo ipsilateral; en el corte coronal, durante apnea tenemos la pérdida del arco subglótico debajo de la cuerda vocal aducida, además se pueden observar los otros signos ya mencionados. 28 En este caso, se encontró signos de parálisis vocal izquierda tanto en la nasolaringoscopía como en tomografía de cuello con contraste, además, con la tomografía de tórax con contraste se pudo determinar que la fuga endoprotésica fue la causa del síndrome de Ortner, ya que, al producir una distención de las paredes del aneurisma residual hubo compresión de las estructuras cercanas a la ventana aortopulmonar incluyendo al nervio laríngeo recurrente izquierdo explicando la aparición de los síntomas en el paciente.…”

Etiopathogenesis of Cardiovocal Syndrome (Ortner’s Syndrome): A Systematic Review of the Literature

“…In addition to stretch and compression various mechanisms of left recurrent laryngeal nerve injury are described as follows: compression by the left main bronchus, mediastinal lymphadenitis, scar formation in the aortic window causing nerve fixity, left heart hypertrophy, atherosclerosis of pulmonary arterial system, mediastinitis, pericardial effusion, obliterative pericarditis, and pleural effusion. 16 Vocal cord paralysis as a postoperative complication of adult cardiac surgery is around 1.1%. Ortner's syndrome may follow permanent endocardial pacemaker, trans-catheter ablation of atrial fibrillation, stenting of the left pulmonary artery, and coil closure of patent ductus arteriosus (PDA The rate of complications was around 3.5% to 5.3%, in another case series.…”