A Rare Case of a 54-year-old Male with Vocal Cord Paralysis Secondary to Left Atrial Enlargement

Abstract

Ortner's syndrome, a rare condition characterized by hoarseness due to left recurrent laryngeal nerve palsy caused by cardiovascular structural compression, is typically associated with an enlarged left atrium secondary to conditions like mitral stenosis. However, recent studies propose additional causes, including compression between the dilated pulmonary artery and the aorta. We present a case of a 54-year-old male with Ortner's syndrome secondary to severe mitral regurgitation and pulmonary hypertension. Our patient presented with a one-month history of progressive dyspnea and hoarseness. Diagnostic imaging revealed cardiac enlargement, left vocal cord paralysis, and severe mitral valve pathology. A transesophageal echocardiogram revealed mitral valve prolapse and severe flail motion of the anterior leaflet. Further assessments through catheterizations confirmed severely elevated right ventricular systolic pressures and pulmonary hypertension. Attempts at mitral valve replacement were hindered by persistently elevated pulmonary pressures, necessitating transfer for specialized care. Our case highlights the broad differentials for hoarseness, emphasizing rare cardiovascular origins such as Ortner's syndrome, involving compression of the left recurrent laryngeal nerve. Early identification is essential, often necessitating comprehensive head and neck examination and radiological studies. While management depends on nerve injury duration, a timely intervention targeting the underlying cardiovascular pathology, including appropriate medical therapy and surgical approaches, can potentially alleviate or reverse nerve damage. Furthermore, our case underscores the significance of initiating guideline-directed medical therapy early in chronic cardiovascular conditions to mitigate cardiac remodeling and prevent complications like left recurrent laryngeal nerve palsy. Timely identification and targeted management of underlying cardiovascular etiologies are crucial in preventing Ortner's syndrome.

Keywords: cardiovocal syndrome; left atrial enlargement; left recurrent laryngeal nerve palsy; mitral valve prolapse; ortner syndrome; pulmonary hypertension; vocal cord paralysis.