Transient Recurrent Laryngeal Nerve Palsy after Interventional Therapy

Guido Mandilaras; Christoph M. Happel; Christoph M. Funk; Nikolaus A. Haas; Matthias Freund; Marcus Fischer

doi:10.1055/a-2003-2023

The Thoracic and Cardiovascular Surgeon, Table of Contents

CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2023; 71(S 04): e1-e7
DOI: 10.1055/a-2003-2023

Pediatric and Congenital Cardiology

Transient Recurrent Laryngeal Nerve Palsy after Interventional Therapy

Authors

Guido Mandilaras

¹Division of Pediatric Cardiology and Pediatric Intensive Care, University Hospital of Munich, LMU, Munich, Germany
Christoph M. Happel

²Department of Pediatric Cardiology and Pediatric Intensive Care, MHH, Hannover, Niedersachsen, Germany
Christoph M. Funk

¹Division of Pediatric Cardiology and Pediatric Intensive Care, University Hospital of Munich, LMU, Munich, Germany
Nikolaus A. Haas

¹Division of Pediatric Cardiology and Pediatric Intensive Care, University Hospital of Munich, LMU, Munich, Germany
Matthias Freund

³Department for Neonatology, Pediatric Intensive Care, Pediatric Cardiology, Pediatric Pneumology and Allergology, Oldenburg Hospital, Oldenburg, Niedersachsen, Germany
Marcus Fischer

¹Division of Pediatric Cardiology and Pediatric Intensive Care, University Hospital of Munich, LMU, Munich, Germany

Abstract

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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.

Keywords

cardiovocal syndrome - stent placement - laryngeal nerve palsy - pediatric

Full Text

References

References
1 Ortner N. Recurrent laryngeal nerve paralysis due to mitral valve stenosis. Wien Klin Wochenschr 1897; 10: 753-755
2 Strychowsky JE, Rukholm G, Gupta MK, Reid D. Unilateral vocal fold paralysis after congenital cardiothoracic surgery: a meta-analysis. Pediatrics 2014; 133 (06) e1708-e1723
3 Stocker HH, Enterline HT. Cardio-vocal syndrome: laryngeal paralysis in intrinsic heart disease. Am Heart J 1958; 56 (01) 51-59
4 García-Torres E, Antón-Pacheco JL, Luna-Paredes MC. et al. Vocal cord paralysis after cardiovascular surgery in children: incidence, risk factors and diagnostic options. Eur J Cardiothorac Surg 2020; 57 (02) 359-365
5 Haas NA, Rickers C, Kozlik-Feldmann R, Cesnjevar R. . Leitlinie Pädiatrische Kardiologie: Aortenisthmusstenose. DGPK; 2018. Accessed January 10, 2023 at: https://www.dgpk.org/fileadmin/user_upload/Leitlinien/2018_06_20_LL__Aortenisthmusstenose.doc.pdf
6 Bertram H, Schneider M, Horke A. . Krankheitsbezeichnung: Periphere Pulmonalarterienstenosen. DGPK; 2018. Accessed January 10, 2023 at: https://www.dgpk.org/fileadmin/user_upload/Leitlinien/peripherePst17_02_18.pdf
7 Jux C, Weil J, Oberhoffer R, Bennink G. . Leitlinie Pädiatrische Kardiologie: Valvuläre Pulmonalstenose. DGPK; 2017. Accessed January 10, 2023 at: https://www.dgpk.org/fileadmin/user_upload/Leitlinien/LL_valvPstnachVSS.pdf
8 Pesti V. 2019. Nervus laryngeus recurrens anatomy and pathology [WWW Document]. ECR 2019 EPOS Accessed on January 16, 2023 at https://epos.myesr.org/poster/esr/ecr2019/C-2121
9 Condon LM, Katkov H, Singh A, Helseth HK. Cardiovocal syndrome in infancy. Pediatrics 1985; 76 (01) 22-25
10 Fan LL, Campbell DN, Clarke DR, Washington RL, Fix EJ, White CW. Paralyzed left vocal cord associated with ligation of patent ductus arteriosus. J Thorac Cardiovasc Surg 1989; 98 (04) 611-613
11 Tammiraju I, Radha Krishna T, Vittal Prasad P, Jagadish Babu K. Ortner's syndrome (cardio vocal hoarseness) – a rare entity in modern era. A case report. IHJ Cardiovas Case Rep (CVCR) 2018; 2 (02) 82-84
12 Subramaniam V, Herle A, Mohammed N, Thahir M. Ortner's syndrome: case series and literature review. Rev Bras Otorrinolaringol (Engl Ed) 2011; 77 (05) 559-562
13 Henry BM, Hsieh WC, Sanna B, Vikse J, Taterra D, Tomaszewski KA. Incidence, risk factors, and comorbidities of vocal cord paralysis after surgical closure of a patent ductus arteriosus: a meta-analysis. Pediatr Cardiol 2019; 40 (01) 116-125
14 Al Kindi AH, Al Kindi FA, Al Abri QS, Al Kemyani NA. Ortner's syndrome: cardiovocal syndrome caused by aortic arch pseudoaneurysm. J Saudi Heart Assoc 2016; 28 (04) 266-269
15 Kaushal S, Backer CL, Patel JN. et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg 2009; 88 (06) 1932-1938
16 Hörmann M, Pavlidis D, Brunkwall J, Gawenda M. Long-term results of endovascular aortic repair for thoracic pseudoaneurysms after previous surgical coarctation repair. Interact Cardiovasc Thorac Surg 2011; 13 (04) 401-404
17 Lew WK, Patel K, Haqqani OP, Weaver FA. Endovascular management of hoarseness due to a thoracic aneurysm: case report and review of the literature. Vasc Endovascular Surg 2009; 43 (02) 195-198
18 Morales JP, Chan YC, Bell RE, Reidy JF, Taylor PR. Endoluminal repair of distal aortic arch aneurysms causing aorto-vocal syndrome. Int J Clin Pract 2008; 62 (10) 1511-1514
19 Wang JY, Chen H, Su X, Zhang ZP. Aortic dissection manifesting as dysphagia and hoarseness: Ortner's syndrome. Am J Emerg Med 2016; 34 (06) 1185.e1-1185.e3
20 Azuma S, Shimada R, Motohashi Y, Yoshii Y. 2022. Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A. Gen Thorac Cardiovasc Surg Accessed on January 18, 2023 at https://doi.org/10.1007/s11748-022-01878-4
21 Matteucci MLS, Rescigno G, Capestro F, Torracca L. Aortic arch patch aortoplasty for Ortner's syndrome in the age of endovascular stented grafts. Tex Heart Inst J 2012; 39 (03) 401-404
22 Stoob K, Alkadhi H, Wildermuth S, Lachat M, Pfammatter T. 2004. Resolution of Hoarseness after Endovascular Repair of Thoracic Aortic Aneurysm: A Case of Ortner's Syndrome. Ann Otol Rhinol Laryngol 113: 43-45 . Available at: https://doi.org/10.1177/000348940411300109
23 Forbes TJ, Kim DW, Du W. et al; CCISC Investigators. Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (Congenital Cardiovascular Interventional Study Consortium). J Am Coll Cardiol 2011; 58 (25) 2664-2674
24 Van Son JA, Mohr FW, Hess H, Hambsch J, Haas GS. Early repair of coarctation of the aorta. Ann Thorac Cardiovasc Surg 1999; 5 (04) 237-244
25 Massey R, Shore DF. Surgery for complex coarctation of the aorta. Int J Cardiol 2004; 97 (Suppl. 01) 67-73
26 Shahrier AZ, Chinchilli VM, Qureshi AM. et al. The incidence of recurrent laryngeal nerve injury resulting in vocal cord paralysis following interventional congenital catheterisation procedures. Cardiol Young 2022; 32 (12) 1952-1956
27 Dalili M, Rao JY, Meraji M. Ductal closure with radiofrequency energy; outcomes of the first series. Indian Heart J 2020; 72 (06) 606-609
28 Fürniss HE, Hummel J, Stiller B, Grohmann J. Left recurrent laryngeal nerve palsy following aortic arch stenting: a case report. World J Cardiol 2019; 11 (12) 316-321
29 Tanidir IC, Yükcü B, Öztürk E, Güzeltaş A. Vocal cord paralysis after transcatheter patent ductus arteriosus closure with AMPLATZERTM Vascular Plug II. Anatol J Cardiol 2019; 21 (06) 345-346
30 Sadiq M, Ur Rehman A, Qureshi AU, Qureshi SA. Covered stents in the management of native coarctation of the aorta–intermediate and long-term follow-up. Catheter Cardiovasc Interv 2013; 82 (04) 511-518
31 Ringel RE, Vincent J, Jenkins KJ. et al. Acute outcome of stent therapy for coarctation of the aorta: results of the coarctation of the aorta stent trial. Catheter Cardiovasc Interv 2013; 82 (04) 503-510
32 Kobayashi D, Turner DR, Humes RA. Left recurrent laryngeal nerve palsy secondary to left pulmonary artery stent in a child. Catheter Cardiovasc Interv 2012; 80 (03) 482-484
33 Tzifa A, Ewert P, Brzezinska-Rajszys G. et al. Covered Cheatham-platinum stents for aortic coarctation: early and intermediate-term results. J Am Coll Cardiol 2006; 47 (07) 1457-1463
34 Assaqqat M, Siblini G, Fadley FA. Hoarseness after pulmonary arterial stenting and occlusion of the arterial duct. Cardiol Young 2003; 13 (03) 302-304
35 Liang CD, Ko SF, Huang SC, Huang CF, Niu CK. Vocal cord paralysis after transcatheter coil embolization of patent ductus arteriosus. Am Heart J 2003; 146 (02) 367-371
36 Hamdan MA, Maheshwari S, Fahey JT, Hellenbrand WE. Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol 2001; 38 (05) 1518-1523
37 LeBlanc JG, Russell JL, Sett SS, Potts JE, Human DG, Culham JA. The evolution of ductus arteriosus treatment. Int Surg 2000; 85 (01) 1-5
38 Hawkins JA, Minich LL, Tani LY, Sturtevant JE, Orsmond GS, McGough EC. Cost and efficacy of surgical ligation versus transcatheter coil occlusion of patent ductus arteriosus. J Thorac Cardiovasc Surg 1996; 112 (06) 1634-1638 , discussion 1638–1639
39 Cowley CG, Orsmond GS, Feola P, McQuillan L, Shaddy RE. Long-term, randomized comparison of balloon angioplasty and surgery for native coarctation of the aorta in childhood. Circulation 2005; 111 (25) 3453-3456
40 Chiu HH, Chiu SN, Hu FC. et al. Late cardiovascular complications after surgical or balloon angioplasty of coarctation of aorta in an Asian cohort. Am J Cardiol 2009; 104 (08) 1139-1144
41 Früh S, Knirsch W, Dodge-Khatami A, Dave H, Prêtre R, Kretschmar O. Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood. Eur J Cardiothorac Surg 2011; 39 (06) 898-904