Loud and clear: A case report on Ortner’s Syndrome (Cardiovocal Syndrome)

Introduction@#Ortner’s syndrome encompasses any intrathoracic process resulting to stretching of the recurrent laryngeal nerve. The stress to this nerve weakens the intrinsic muscles of the larynx and manifests as vocal hoarseness.@*Case@#A 46-year-old female was admitted due to progressive hoarseness. She tolerated this for six months until the onset of other symptoms like orthopnea, bipedal edema, and chest pain. She consulted various doctors and was initially diagnosed with chronic laryngitis from gastroesophageal reflux disease. She was given omeprazole and spironolactone that afforded little help. On examination, the precordium was dynamic with heaves and thrills, PMI was displaced, and systolic murmurs were heard. The ECG revealed left ventricular hypertrophy with left atrial abnormalities. Chest radiograph showed leftsided cardiomegaly. A 2D-echocardiogram divulged severe mitral regurgitation, anterior mitral valve leaflet thickening, and dilated left atrium. Therefore, the impression was Ortner’s syndrome, rheumatic heart disease. The patient underwent mitral valve replacement. She was given warfarin, bisoprolol, losartan, spironolactone, and vitamin B complex. At subsequent visits, she reported improvement in her voice. Penicillin injections were also given as secondary prophylaxis. A repeat 2D-echocardiogram displayed a decrease in size of the left atrium.@*Conclusion@#This case has emphasized three important points: First, a comprehensive history and physical examination is vital to reach the correct diagnosis. Second, once the common causes of hoarseness have been excluded yet symptoms persist, it is therefore prudent to look beyond the larynx. And third, the vocal cord paralysis experienced by the patient is just the tip of the iceberg. Her heart is the one dying to be heard.

Acoustic variations associated with congenital heart disease / 소아과

PURPOSE: To investigate the nature of deviant voice physiology in preoperative children with congenital heart disease. METHODS: Ninety-four children with congenital heart disease were enrolled. Their cries and related acoustic variables (fundamental frequency, duration, noise to harmonic ratio, jitter, and shimmer) were analyzed using a multi-dimensional voice program. RESULTS: The average fundamental frequency showed a significant decrease in patent ductus arteriosus, ventricular septal defect, and tetralogy of Fallot, except in atrial septal defect and pulmonary stenosis. The length of the analyzed sample (duration) did not show a significant difference when compared with the control group. There was a significant increase in jitter percent in ventricular septal defect, patent ductus arteriosus, and atrial septal defect. There was an increase in shimmer in ventricular septal defect, patent ductus arteriosus, and atrial septal defect. The noise-to-harmonic ratio increased in ventricular septal defect, patent ductus arteriosus, and atrial septal defect but there was no significant difference in pulmonary stenosis and tetralogy of Fallot. While analyzing acoustic variables, the voice change was significantly higher, especially in patent ductus arteriosus followed by ventricular septal defect and atrial septal defect. Most of these acoustic variables were deviant in left-to-right shunt lesions in congenital heart disease, especially in patent ductus artriosus. CONCLUSION: The results of the voice change analysis of preoperative children with congenital heart disease revealed that the acoustic variables differed by each congenital heart disease. Moreover, the acoustic variables were prominently deviant in congenital heart disease with left-to-right shunts.

Vocal Cord Paralysis in Patent Ductus Arteriosus and Primary Pulmonary Hypertension

Nowadays left vocal cord paralysis is a rare presenting sign of cardiovascular diseaes, associated with pulmonary hypertension. This condition is known as Cardiovocal syndrome. The mechanism of this condition is thought to be due to compression of the recurrent laryngeal nerve by a dilated, tense pulmonary artery against its adjacent structure. Two patients complaining hoarseness were proven to have cardiovascular diseases. The one had patent ductus arteriosus and the other had primary pulmonary hypertension. A causal relation between cardiovascular problem and the vocal cord paralysis is proposed. We describen two cases of Cardiovocal syndrome with a review of the literature.