Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-called iatrogenic Ortner&amp;#8217;s (cardiovocal) syndrome

Yuan, Shi‐Min

doi:10.5603/cj.2012.0106

Cited by 13 publications

(15 citation statements)

References 67 publications

(102 reference statements)

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“…A systematic review of hoarseness after thoracic cardiovascular surgery, which included newborn and paediatric patients, suggested that the rate of persistent hoarseness was 33%. 14 In our study, the overall rates of partial recovery and persistent VCP were 34.4 and 21.8%, respectively. Overall, only 43.8% of the patients had full recovery after follow-up at 1 year.…”

Section: Discussionmentioning

confidence: 43%

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Taenaka

Shibata²,

Okitsu³

et al. 2017

European Journal of Anaesthesiology

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BACKGROUNDVocal cord paralysis (VCP) is a rare complication of thoracic cardiovascular surgery. In severe cases, life-threatening airway obstruction may occur.OBJECTIVETo evaluate the incidence and severity of VCP among patients who underwent thoracic cardiovascular surgery and to identify possible risk factors.DESIGNSingle-centre retrospective review of adult patients.SETTINGOsaka University Hospital, Suita, Japan, from January 2013 to August 2015.PATIENTSWe included 688 patients in the final analysis. Preoperative, intraoperative and postoperative data were collected from medical records. Patients with preoperative VCP or tracheostomy prior to extubation were excluded. The VCP severity in relation to functional recovery was graded using the following categories: absent; mild, remission at 6 months; moderate, partial or persistent VCP at 6 months; or severe, airway obstruction after extubation requiring reintubation. An otolaryngologist diagnosed all VCP cases.MAIN OUTCOME MEASURESThe incidence and severity of VCP after extubation.RESULTSThe incidence (number) of VCP was 4.7% (32), with those of mild, moderate and severe VCP being 1.7% (12), 1.5% (10) and 1.5% (10), respectively. The ICU stay was significantly longer in patients with severe VCP than in patients without VCP [12.5 days (interquartile range 5.5 to 25.5) vs. 3 days (interquartile range 2 to 5), P = 0.0002]. In our multivariable analysis, type 2 diabetes mellitus [odds ratio (OR) 1.853, P = 0.009], intubation period (OR per 24 h 1.136, P = 0.014), ascending aortic arch surgery with brachiocephalic artery reconstruction (OR 8.708, P < 0.001) and ventricular assist device implantation (OR 3.460, P = 0.005) were independent predictors for VCP.CONCLUSIONThe identification of these risk factors may facilitate screening for VCP before extubation and possibly help anaesthesia personnel to be prepared to treat VCP-related airway obstruction should it occur.

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Section: Discussionmentioning

confidence: 43%

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Taenaka

Shibata²,

Okitsu³

et al. 2017

European Journal of Anaesthesiology

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“…Mann-Whitney U test or independent sample t test was used between two groups, and analysis of variance was used to assess the significance of differences among 3 groups as appropriate. We enrolled patients scheduled for cardiac surgery due to the lengthy intubation involved during surgery and during monitoring in intensive care [10][11][12]. We observed correlation between total length of intubation and effects in laryngopharyngeal structures.…”

Section: Discussionmentioning

confidence: 99%

Uzun süreli entübasyon yapılmış hastalarda laringofaringeal etkilerin değerlendirilmesi

Şimşek

Çalık

et al. 2018

Turkish Journal of Clinics and Laboratory

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Aim: Open cardiovascular surgery involves prolonged intubation, postoperatively in the intensive care unit monitoring. The purpose of this study was to investigate the effects of long-term intubation after coronary artery surgery on laryngeal and pharyngeal structures and the probable underlying causes for such effects. Material and Methods: Forty two patients undergoing cardiovascular surgery were included in the study. All patients underwent endoscopic examination in the preoperative period and approximately 7th postoperative day. Results: Mean age of the patients was 61±9.98 years, mean duration of intubation was 14.80±3.41 hours (h) and mean size of intubation tube used was 8.02±0.45 mm. The number of preoperative smokers was 25(59.52%), and number of patients with preoperative gastroesophageal reflux disease symptoms were 8(19.04%). The level of postoperative laryngeal and pharyngeal pathological findings were 38.09%. Postoperative laryngeal and pharyngeal pathological findings were correlated with age, length of intubation and preoperative presence of the gastroesophageal reflux disease symptoms (p˂0.05). However, no statistically significant correlation was determined between postoperative pathological finding and sex, tube type, tube diameter, smoking status. Conclusion: Age, presence of gastroesophageal reflux disease, length of intubation were identified as risk factors for the development of postoperative pathological laryngopharyngeal findings.

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“…The left RLN is more prone to injury by compression or traction because of its lengthy course, especially around the aortic arch and also its close relationship with major blood vessels in the mediastinum. The association of left RLN paralysis with a cardiovascular pathology was termed as cardiovocal syndrome (5,6,11,12). It was first described in a series of three cases of mitral stenosis suffering from hoarseness by Ortner in 1897 (5).…”

Section: Discussionmentioning

confidence: 99%

“…It was first described in a series of three cases of mitral stenosis suffering from hoarseness by Ortner in 1897 (5). A wide variety of diseases, including congenital or adult cardiac conditions (such as mitral valve disorders, aneurysms of aorta and pulmonary artery, pulmonary hypertension, and tumors of left atrium and ventricles) and iatrogenic conditions (such as cardiovascular surgery and cardiac interventions) can result in hoarseness through RLN paralysis by either compressing or stretching effects (6,11,12). It was hypothesized that palsy results from compression of the left RLN between the pulmonary artery and either the aorta or aortic ligament due to cardiopulmonary pathology (6).…”

Section: Discussionmentioning

confidence: 99%

Laryngeal Electromyography is Helpful for Cardiovocal Syndrome

Akbulut

İnan

Demir

et al. 2016

Acta Med. (Hradec Kralove, Czech Repub.)

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Laryngeal electromyography is used in the evaluation of vocal cord paralysis to confirm the diagnosis, to guide the diagnostic work-up for etiology, to provide prognostic information and to help choose the correct treatment for the patient. Cardiovocal syndrome is characterised by vocal cord paralysis due to a cardiovascular disease. A wide spectrum of conditions can result in this syndrome. Here we present a case of cardiovocal syndrome in association with primary pulmonary hypertension. Laryngeal electromyography was used to guide the work-up of differential diagnosis and also for further intervention with respect to vocal cord paralysis in this patient.

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Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-called iatrogenic Ortner’s (cardiovocal) syndrome

Abstract: Background:The clinical characteristics and outcomes of hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation have not been systematically elucidated.

Cited by 13 publications

References 67 publications

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Uzun süreli entübasyon yapılmış hastalarda laringofaringeal etkilerin değerlendirilmesi

Laryngeal Electromyography is Helpful for Cardiovocal Syndrome

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