Ortner's syndrome: Looking back at this rarity

Abstract

Ortner's syndrome or the cardiovocal syndrome is characterized by hoarseness of voice which is caused by the paralysis of the left recurrent laryngeal nerve as a result of cardiovascular causes. We report two cases; the first one was a 40-year-old male, who presented with hoarseness of voice, dyspnea on exertion, and central chest pain of 6-month duration. Videolaryngoscopy revealed left vocal cord palsy and an echocardiograph showed severe calcific mitral stenosis. The patient underwent mitral valve (MV) replacement and recovered left vocal cord function within 3 months. The second patient was a 52-year-old female, who presented with dyspnea on exertion, intermittent palpitations, and hoarseness of voice. Videolaryngoscopy revealed left vocal cord palsy. Echocardiography revealed features of rheumatic heart disease with severe mitral stenosis, moderate mitral regurgitation, severe tricuspid regurgitation, dilated left atrium, right atrium and right ventricle, and a left atrial appendage thrombus. The patient was subsequently taken up for MV replacement and left atrial thrombectomy, but the left vocal cord palsy persisted after surgery. Cardiovocal syndrome is rare in the general population but associated with causes such as aneurysms and MV stenosis. A high index of suspicion is needed to make an early diagnosis which can lead to surgical correction of the underlying cardiovascular disease, and the pals may resolve spontaneously following treatment.