Ortner's syndrome revisited

Abstract

Hoarseness of voice due to paralysis of the left recurrent laryngeal nerve caused by a dilated left atrium in mitral stenosis as discussed by Ortner, is a subject of controversy. Different authors have cited different mechanisms as explanation. A variety of cardiac problems such as primary pulmonary hypertension, ischaemic heart disease, various congenital heart disorders can all lead to paralysis of the left recurrent laryngeal nerve. Most authors believe that pressure in the pulmonary artery causes the nerve compression. In Papua New Guinea cor pulmonale and rheumatic heart disease are the commonest cardiac disorders seen. Ortner's syndrome is a rarity and has never been reported from here before. Here three different case reports are presented with mitral stenosis, primary pulmonary hypertension and combined mitral stenosis and regurgitation and the pathogenesis of hoarseness is discussed.

Cardiovocal Syndrome: A Systematic Review

“…3,4 It was also associated with double outlet right ventricle, 5 Ebstein's anomaly, 6 patent ductus arteriosus (PDA), 7 and Eisenmenger's complex. 8 Ductal ligation and transcatheter closure of PDA is associated with a risk of LRLN palsy. 9,10 Infants, who are less than 1500 g, premature, and younger, are have a higher risk of developing LRLN palsy.…”

Giant Left Atrium Associated With Mitral Valve Prolapse

“…Although he attributed the hoarseness to paralysis of the left vocal cord due to compression of the left recurrent laryngeal nerve between the enlarged left atrium and the arch of the aorta, his explanation has been questioned by subsequent workers. According to a literature review, Sengupta et al 5 concluded that the etiology of left recurrent laryngeal nerve paralysis was compression of the nerve between the enlarged tense left pulmonary artery and the aorta at the ligamentum arteriosum. That is the reason why Ortner syndrome may also occur in primary pulmonary hypertension, Eisenmenger syndrome due to atrial septal defect where the left atrium is not enlarged, and even aortic aneurysms with encroachment of aorticopulmonary window and resultant compression of the left recurrent laryngeal nerve.…”

“…That is the reason why Ortner syndrome may also occur in primary pulmonary hypertension, Eisenmenger syndrome due to atrial septal defect where the left atrium is not enlarged, and even aortic aneurysms with encroachment of aorticopulmonary window and resultant compression of the left recurrent laryngeal nerve. 5 Finally, I wish to echo Hurst's teaching that a giant left atrium is more commonly associated with mitral regurgitation than mitral stenosis and rheumatic than nonrheumatic cause of mitral regurgitation. However, like everything in medicine, there may always be exceptions.…”

Concurrent Takayasu’s Arteritis and Antineutrophil Cytoplasmic Antibody-related Glomerulonephritis Related to Use of Propylthiouracil: Figure 1.

“…The ascending and descending thoracic aortic walls were thickened to 5 mm. Laryngoscopy revealed paralysis of the left vocal fold consistent with pressure on the left branch of the recurrent laryngeal nerve (also known as Ortner's effect 3 ).…”