Left recurrent laryngeal nerve palsy following aortic arch stenting: A case report

Abstract

BACKGROUNDAortic arch stenting is continuously emerging as a safe and effective option to alleviate aortic arch stenosis and arterial hypertension.CASE SUMMARYWe present a 15-year-old girl with aortic arch hypoplasia who had undergone implantation of an uncovered 22 mm Cheatham-Platinum stent due to severe (native) aortic arch stenosis. On follow-up seven months later, she presented a significant re-stenosis of the aortic arch. A second stent (LD Max 26 mm) was implanted and both stents were dilated up to 16 mm. After an initially unremarkable post-interventional course, the patient presented with hoarseness five days after the intervention. MRI and CT scans ruled out an intracranial pathology, as well as thoracic hematoma, arterial dissection, and aneurysm around the intervention site. Laryngoscopy confirmed left vocal fold paresis attributable to an injury to the left recurrent laryngeal nerve (LRLN) during aortic arch stenting, as the nerve loops around the aortic arch in close proximity to the area of the implanted stents. Following a non-invasive therapeutic approach entailing regular speech therapy, the patient recovered and demonstrated no residual clinical symptoms of LRLN palsy after six months.CONCLUSIONLeft recurrent laryngeal nerve palsy is a rare complication of aortic arch stenting not previously reported.

The sources of innervation of the aortic arch and thoracic aorta in human fetuses

“…The obtained results on the topographic anatomical interrelations of the left recurrent laryngeal nerve and the aortic arch correspond with the data of individual authors [13][14][15][16] .…”

The incidence of recurrent laryngeal nerve injury resulting in vocal cord paralysis following interventional congenital catheterisation procedures

“…12 Literature review demonstrated only 1 case report of a patient who developed vocal cord paralysis secondary to recurrent laryngeal nerve injury after re-stenting of coarctation of the aorta and the patient recovered with no intervention within 6 months. 13 While the statistical significance of this finding was not calculated, it raises the possibility that recurrent laryngeal nerve injury secondary to interventional congenital catheterisation procedures is of lower risk than cardiothoracic surgery. Interventional procedures may cause a stretch or compression phenomenon of the left recurrent laryngeal nerve versus true injury during surgical procedures.…”

A vocal cord palsy caused by the uterine cancer metastatic tumor in the mediastinum revealed in a patient with a thyroid lesion: a case report and review of the literature

“…The RLN passes directly underneath the aortic arch. Subsequent nerve stretching caused left RLN palsy, which was recovered in advance [ 17 ]. Also, the other endovascular surgery with aortic stent-graft placement can entail left VCP.…”