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Mitral regurgitation, mitral stenosis, and mitral annular calcification in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Hasan Ahmad, Wilbert S. Aronow
Hemoptysis occurs in these patients as pulmonary venous pressure increases, opening collaterals for runoff to the bronchial veins. These protrude into the lumen of the bronchi and, when rupture occurs, cause hemoptysis (8). Ortner’s syndrome (paralysis of the left vocal cord) can occur with the recurrent laryngeal nerve, which hooks around the ligamentum arteriosus being stretched by the enlarging left pulmonary artery and left atrium (11).
Clinical features of mitral stenosis
Published in Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi, Mitral Stenosis, 2018
Ortner’s syndrome, a clinical entity manifested by hoarseness of voice, caused by an impaired ability of the left recurrent laryngeal nerve to transmit impulse to the laryngeal musculature because of stretching or impingement of the nerve from the disease-induced changes in cardiac or greater vessel anatomy. Hoarseness of voice due to paralysis of the left recurrent laryngeal nerve postulated as caused by a dilated LA in MS was first discussed by Nobert Ortner in 1897. A variety of conditions can lead to paralysis of the left recurrent laryngeal nerve; these include thoracic aortic aneurysm, patent ductus arteriosus, primary pulmonary hypertension, atrial and ventricular septal defect, Eisenmenger’s syndrome, and recurrent pulmonary embolism. In MS, its incidence ranges from 0.6% to 5%. Currently, it is believed that dilated hypertensive pulmonary arteries impinge on the recurrent laryngeal nerve. The most common cardiovascular cause—other than aortic aneurysm—is compression of the left recurrent laryngeal nerve by a hypertensive dilated PA, and this seems the most plausible reason in MS, as LA does not come in close proximity to the left recurrent laryngeal nerve, even with aneurysmal dilation.
A spontaneous partially thrombosed ductal aneurysm presenting with left recurrent laryngeal nerve palsy
Published in Acta Oto-Laryngologica Case Reports, 2020
Abhilasha Goswami, Anandita Das
Serious complications of spontaneous ductus arteriosus aneurysm are rupture, erosion, infection, and thromboembolism [3,4]. Ductal diverticulum aneurysms have also been reported in association with systemic connective tissue diseases like Ehlers–Danlos syndrome and Marfan’s syndrome [9,10]. Previously, most cases were discovered at autopsy or in those undergoing cardiac surgery for another indication [3]. Widespread use of cross-sectional imaging in the adult population has led to increased diagnosis of this often asymptomatic abnormality. The reversibility of hoarseness after treatment of the primary cause in Ortner’s syndrome is limited [19,20], and is dependent on the degree and duration of recurrent laryngeal nerve injury. This again reinforces the importance of appropriate and timely management of these patients.
Cardiovocal syndrome (Ortner syndrome) associated with secondary pulmonary arterial hypertension in a patient with mixed connective tissue disease
Published in Modern Rheumatology Case Reports, 2018
Manami Hirata, Katsue Sunahori-Watanabe, Miyuki Isihara, Nobuyuki Shibuto, Sumie Hiramatsu, Yoshia Miyawaki, Michiko Morishita, Keiji Ohashi, Eri Katsuyama, Haruki Watanabe, Tomoko Kawabata, Ken-Ei Sada, Jun Wada
Although MCTD can be complicated with PAH [4,5], there is only one reported case of Ortner syndrome caused by PAH associated with MCTD [13]. Compared to patients with LRLN paralysis due to secondary PAH associated with SLE, patients with MCTD, including ours, eventually recovered from LRLN paralysis although it took more than several months. The interval between the improvement of the primary disease and the recovery from the vocal cord palsy was also reported in cardiovocal syndrome with primary [10] or left heart diseases-associated PAH [8,9], which suggested the time needed for the enlarged arteries to contract and release to the nerve. The efficacy of treatment for vocal cord palsy associated with PAH may also be dependent on the disease spectrum and severity or interval between the appearance of the symptom and the diagnosis of the primary etiology to initiate the treatment.