Tetralogy of Fallot (Eisemenger Type) With Hypoplasia of the Dextroposed Aorta

Talley, James E.; Fowler, Kenneth G.

doi:10.1097/00000441-193605000-00003

Cited by 28 publications

(5 citation statements)

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“…He deduced the cause to be compression of the left recurrent laryngeal nerve by an enlarged left atrium 2 . Since then various authors have recorded their experiences of recurrent laryngeal nerve involvement in various cardiac disorders such as Eisenmenger complex 3 , left ventricular failure 4 , atrial septal defect 5 , patent ductus arteriosus (PDA) 6 , 7 , primary pulmonary hypertension 8 , 9 , 10 recurrent pulmonary artery embolism 11 , mitral regurgitation 12 , atrial myxoma 13 , left ventricular aneurysm 14 , cor pulmonale 15 and various types of aortic aneurysms 16 , 17 , 18 , 19 , 20 , 21 .…”

Section: Discussionmentioning

confidence: 99%

Ortner's syndrome: case series and literature review

Subramaniam¹,

Tv²,

Mohammed³

et al. 2011

Braz. j. otorhinolaryngol. (Impr.)

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More than a century ago, Ortner described a case of cardiovocal syndrome wherein he attributed a case of left vocal fold immobility to compression of the recurrent laryngeal nerve by a dilated left atrium in a patient with mitral valve stenosis. Since then, the term Ortner's syndrome has come to encompass any nonmalignant, cardiac, intrathoracic process that results in embarrassment of either recurrent laryngeal nerve-usually by stretching, pulling, or compression; and causes vocal fold paralysis. Not surprisingly, the left recurrent laryngeal nerve, with its longer course around the aortic arch, is more frequently involved than the right nerve, which passes around the subclavian artery.Objectives: To discuss the pathogenesis of hoarseness resulting from cardiovascular disorders involving the recurrent laryngeal nerve along with the findings of literature review. Materials and methods:This paper reports a series of four cases of Ortner's syndrome occurring due to different causes.Design: Case study. Result:Ortner's syndrome could be a cause of hoarseness of voice in patients with cardiovascular diseases. Conclusion:Although hoarseness of voice is frequently encountered in the Otolaryngology outpatient department, cardiovascular-related hoarseness is an unusual presentation. Indirect laryngoscopy should be routinely performed in all cases of heart disease. Braz J Otorhinolaryngol. 2011;77(5):559-62. ORIGINAL ARTICLE

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Section: Discussionmentioning

confidence: 99%

Ortner's syndrome: case series and literature review

Subramaniam¹,

Tv²,

Mohammed³

et al. 2011

Braz. j. otorhinolaryngol. (Impr.)

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“…Since the first description by Ortner in 1897, several causes of cardiovocal syndrome have been reported. These causes include left ventricular failure, an atrial septal defect, Eisenmenger syndrome, mitral valve prolapse, primary pulmonary hypertension, and an aortic aneurysm [3][4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Dysphagia and Hoarseness Associated with Painless Aortic Dissection: A Rare Case of Cardiovocal Syndrome

2006

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Cardiovocal syndrome (Ortner's syndrome) is characterized by left recurrent laryngeal nerve palsy due to cardiovascular disease, but in rare cases it can also be caused by aortic dissection. An 81-year-old man with hypertension was admitted to the hospital with aspiration pneumonia. He had been developing progressive dysphagia and hoarseness for several months before admission. A videofluoroscopic swallowing study showed supraglottic penetration with barium paste and liquid. Laryngoscopy and electromyography revealed left vocal cord palsy caused by left recurrent laryngeal neuropathy, and a contrast-enhanced chest CT revealed dissection of the aortic arch.

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“…Other authors4 5 [8][9][10][11] have suggested that the condition is typified by a true dextroposition of the aorta with a rightward displacement and a clockwise rotation of the aortic root, particularly in cases with severe infundibular obstruction. 8 Two-dimensional echocardiography has been used to show the ov'erriding aorta over the right ventricle in patients with tetralogy of Fallot,'2-1 but no criteria have been proposed to differentiate a simple exaggeration of the normal overriding from a true dextroposition.…”

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confidence: 99%

Is the aorta truly dextroposed in tetralogy of Fallot? A two-dimensional echocardiographic answer.

Isaaz¹,

Cloez²,

Marçon³

et al. 1986

Circulation

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The embryogenesis of tetralogy of Fallot is still much debated. In particular, the dextroposition of the aorta is not considered by all pathologists as a genuine abnormality in this congenital heart disease but rather as a false impression due to an exaggeration of the normal overriding caused by dilatation of the aorta secondary to abnormal hemodynamics. We used two-dimensional echocardiography to examine the spatial position of the aortic root in 22 patients with tetralogy of Fallot (aged 5 days to 24 years, mean 6.4 years) and in 23 normal subjects (aged 1 month to 27 years, mean 7.6 years). Using the parasternal short-axis view, we determined the percent rightward displacement of the aortic root in relation to the plane of the atrial septum, and the relationship between the aortic cusps and the atrial septum. We measured the value of the angle 0, which was defined as the angle between the plane of the atrial septum and the plane of the left coronary-noncoronary commissure and leaflet appositional plane. In the control group, the aortic root was displaced to the right by only 23.6 + 7.6%; the atrial septum crossed the posterior aspect of the aortic root at the middle (n = 19) or at the right half of the posterior cusp (n = 4), and the angle 0 had a value of 43.3 + 8.8 degrees. In the 22 patients with tetralogy, the percent rightward shift of the aortic root was augmented to 55.5 + 9% (p < .001) and the atrial septum was related to the posterior commissure in 14 patients, to the left coronary cusp in two patients, and to the left fourth of the posterior cusp in six patients; the angle 0 had a value of 9.2 11.2 degrees (p < .001). In the two groups, the position of the commissure between the right coronary and left coronary aortic cusps was similar in relation to a line passed forward from the atrial septum. We conclude that the aorta is truly dextroposed in tetralogy of Fallot, with a rightward shift due to a clockwise rotation of the aortic root (looking downstream), and that the axis of this rotation is the anterior aortic commissure. Our echocardiographic findings, which confirm conclusions of previous investigators based on pathologic anatomy, support the embryologic hypothesis of the lack of conal rotation in tetralogy of Fallot and permit a quantitation of the effects of this morphogenetic mechanism. Circulation 73, No. 5, 892-899, 1986. IN THE PAST, the terms "dextroposition" and "overriding" have been used interchangeably. However, overriding of the aorta should not be confused with dextroposition. Overriding of the aorta over the right ventricle occurs in the normal heart because of the sigmoid interventricular septum' as well as in hearts with isolated infundibular perimembranous ventricular septal defect2' 3 and can be considered a normal anatomic feature.4 The term dextroposition indicates a pathologic condition with a rightward displacement of the aortic root.4' There has been considerable debate concerning whether a true dextroposition of the aorta exists in tetralogy of Fallot. Some ...

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Tetralogy of Fallot (Eisemenger Type) With Hypoplasia of the Dextroposed Aorta

Cited by 28 publications

References 0 publications

Ortner's syndrome: case series and literature review

Ortner's syndrome: case series and literature review

Dysphagia and Hoarseness Associated with Painless Aortic Dissection: A Rare Case of Cardiovocal Syndrome

Is the aorta truly dextroposed in tetralogy of Fallot? A two-dimensional echocardiographic answer.

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