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