Transient Recurrent Laryngeal Nerve Palsy after Interventional Therapy.

Abstract

BACKGROUND:

Hoarseness due to laryngeal nerve injury is a known complication after cardiothoracic surgery involving the aortic arch. However, this complication is only rarely reported after catheter interventions.

RESULTS:

In this article we present the unusual case of a left-sided vocal cord paralysis in four patients after primary stenting of a re-coarctation, re-dilatation of a stented coarctation, a primary stenting of the left pulmonary artery (LPA), and prestenting for percutaneous pulmonary valve implantation with dilation of the LPA. After implanting bare metal stents, it is common practice, whilst contemplating the diameters of the adjacent structures, to optimize the stent diameter in a two-step procedure and dilate the stent until a maximum diameter is achieved and there is no residual gradient after applying this technique. Four of our patients experienced hoarseness after the intervention and a vocal cord paralysis was diagnosed. Angiography revealed no signs of extravasation or dissection. Clinical symptoms improved over the course of the following 6 months; patients with interventions at the aortic arch showed a complete remission, patients with procedures involving the LPA showed only mild regression of the symptoms.

CONCLUSION:

To our knowledge, this complication (Ortner's syndrome, cardiovocal syndrome) after such interventions has rarely been reported before. Although a rare complication, the recognition of these symptoms may support colleagues in managing affected patients. In addition, awareness for hoarseness after interventional therapies and systematic screening for this complication might help to identify patients at risk in the future.

• Authors: Guido Mandilaras, Christoph M Happel, Christoph M Funk, Nikolaus A Haas, Matthias Freund, Marcus Fischer
• Journal: The Thoracic and cardiovascular surgeon (Thorac Cardiovasc Surg) Vol. 71 Issue S 04 Pg. e1-e7 (01 2023) ISSN: 1439-1902 [Electronic] Germany
• PMID: 36549306 (Publication Type: Case Reports, Journal Article)
• Copyright: The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Topics

• Humans
• Vocal Cord Paralysis (diagnostic imaging, etiology)
• Hoarseness (therapy, complications)
• Treatment Outcome
• Aorta, Thoracic
• Pulmonary Artery
• Recurrent Laryngeal Nerve