Ortner's: A Cardiovocal Syndrome

Abstract

In 1897, Norbert Ortner, an Austrian physician, described three cases of left-sided vocal cord palsy associated with mitral valve stenosis. He postulated that this was due to associated atrial enlargement causing a compressive effect on the left recurrent laryngeal nerve as it coursed under the aortic arch within the mediastinum. More recently, the syndrome, which bears his name – Ortner's syndrome – has come to refer to a vocal cord palsy associated with a number of cardiac and vascular conditions, and has also been referred to as the cardiovocal syndrome. This study presented the case of a 77-year-old male, along with a literature review, who presented with a 2-month history of a vocal hoarseness of unknown cause. Computed tomography of the brain, head, neck, and chest was undertaken to look for a lesion along the distribution of the vagus and recurrent laryngeal nerves. Computed tomography identified a large saccular aneurysm arising from the arch of the aorta, which was the likely cause of his left-sided vocal cord palsy. The patient was referred to a cardiothoracic surgeon at the current hospital for consideration of surgical management. He was also referred on to an otolaryngologist with an interest in voice and expertise in the treatment of vocal cord paralysis in the same vicinity. He underwent a total aortic arch replacement and frozen elephant trunk to treat the arch aneurysm. Postoperatively, his vocal cord palsy was noted to persist and remained unchanged. He ultimately underwent vocal cord medialisation and is being monitored.