Ortner’s syndrome: Cardiovocal syndrome caused by aortic arch pseudoaneurysm

Abstract

72-year-old hypertensive presented with two weeks history of left sided chest pain and hoarseness. Workup demonstrated a pseudoaneurysm in the lesser curvature of the distal aortic arch opposite the origin of the left subclavian artery from a penetrating atherosclerotic ulcer. Following a left carotid-subclavian bypass, endovascular stenting of the aorta was performed excluding the pseudoaneurysm. Patient had excellent angiographic results post-stenting. Follow up at 12 weeks demonstrated complete resolution of his symptoms and good stent position with no endo-leak. Ortner's syndrome describes vocal changes caused by cardiovascular pathology. It should be included in the differential diagnosis of patients with cardiovascular risk factors presenting with hoarseness. This case demonstrates the use of endovascular stents to treat the causative pathology with resolution of symptoms. In expert hands, it represents low risk, minimally invasive therapeutic strategy with excellent early results in patients who are high risk for open procedure.

Hoarseness Due to Aortic Arch Aneurysms

“…Hoarseness was a sole symptom in 32 (36.8%) patients [ 1 , 9 , 11 , 12 , 18 , 21 , 22 , 31 - 34 , 36 , 41 , 43 , 45 , 47 , 50 , 54 - 56 , 58 , 59 , 62 , 63 , 65 - 68 , 74 , 75 ] , a major symptom in 34 (39.1%) patients [ 2 , 5 , 6 , 8 , 10 , 13 - 16 , 19 , 24 , 28 , 31 , 32 , 38 , 39 , 44 , 46 , 49 , 51 - 53 , 57 , 61 , 64 , 70 ] , and an accompanying symptom in 21 (24.1%) patients [ 3 , 4 , 7 , 17 , 20 , 23 , 25 - 27 , 29 , 30 , 32 , 35 , 37 , 40 , 42 , 48 , 60 , 69 , 72 , 73 ] (χ [ 2 ] =5.1, P =0.079).…”

“…The arch aneurysms were purely arch-affected in 76 (87.4%) patients [ 1 , 2 , 4 , 6 - 18 , 20 - 49 , 52 - 56 , 58 - 61 , 63 - 66 , 68 - 71 , 73 , 74 ] , the aneurysm was extending from the ascending aorta to the aortic arch in four (4.6%) patients [ 3 , 31 , 57 , 62 ] , from the aortic arch to the descending aorta in three (3.4%) patients [ 51 , 67 , 75 ] , and there were arch-thoracoabdominal aortic aneurysm [ 19 ] , aneurysm extending from the ascending aorta to the descending aorta [ 72 ] , arch and left subclavian artery aneurysms [ 50 ] , and an aortic arch aneurysm with a proximal descending aorta aneurysm [ 5 ] in one (1.1%) patient, each.…”

“…A mural thrombus was present in 34 (20.7%) patients [ 1 , 2 , 7 , 8 , 11 - 14 , 18 , 19 , 22 , 29 , 31 , 34 , 38 , 39 , 42 , 45 , 46 , 48 - 52 , 54 - 56 , 60 , 62 , 63 , 68 - 70 ] . In 12 (13.8%) patients, the arch aneurysms were pseudoaneurysms [ 4 , 17 , 26 , 33 , 36 , 41 , 43 , 46 , 48 , 55 ], 73 ] . Left vocal cord paralysis was evidenced in 39 (44.8%) patients: by laryngoscopic examination in 34 (87.2%) patients [ 2 - 5 , 7 - 9 , 11 , 12 , 14 , 18 , 20 , 21 , 23 - 26 , 33 - 39 , 41 , 42 , 45 - 47 , 52 , 56 - 59 , 62 ]- 64 ,[ 66 , 68 , 71 , 73 - 75 ] , by nasopharyngoscopy in three (7.7%) patients [ 55 , 69 ,…”

“…Nine patients chose conservative treatment due to their poor conditions that could not support a surgical treatment [ 2 , 11 , 44 , 47 , 54 , 61 , 71 , 72 , 74 ] . Of the remaining 42 patients, 19 (19/42, 45.2%) patients underwent a surgical treatment (an arch replacement in 16 [16/19, 84.2%] patients [ 5 , 10 , 12 , 15 , 21 , 27 , 29 - 32 , 38 , 48 , 65 ] , patch reconstruction of the aorta in two [2/19, 10.5%] patients [ 13 , 17 ] , and the operation method was not indicated in one [1/19, 5.3%] patient [ 57 ] ), 18 patients (18/42, 42.9%) received an endovascular aortic repair by a stent graft insertion [ 6 , 26 , 28 , 33 , 34 , 40 - 42 , 56 , 58 , 75 ] , and five (5/42, 11.9%) patients were treated with hybrid procedures, including stent graft plus woven Dacron vascular graft in two patients [ 50 , 53 ] , and endovascular frozen elephant trunk replacement of the ascending aorta and aortic arch [ 70 ] , left carotid-subclavian bypass plus stent graft [ 4 ] , and open-arch repair and descending aorta stent grafting [ 43 ] in one patient, each.…”

“…A mural thrombus was present in 34 (20.7%) patients [ 1 , 2 , 7 , 8 , 11 - 14 , 18 , 19 , 22 , 29 , 31 , 34 , 38 , 39 , 42 , 45 , 46 , 48 - 52 , 54 - 56 , 60 , 62 , 63 , 68 - 70 ] . In 12 (13.8%) patients, the arch aneurysms were pseudoaneurysms [ 4 , 17 , 26 , 33 , 36 , 41 , 43 , 46 , 48 , 55 , 73 ] .…”