Cardiovocal Syndrome Associated With Huge Left Atrium
A 46-year-old woman was admitted to our cardiology department because of dyspnea with exertion and hoarseness lasting for a long time. She had irregular medical follow-ups because of rheumatic mitral valve disease. Atrial fibrillation with a ventricular rate of 90/min was present in her electrocardiography. Chest teleradiography showed an increased cardiothoracic ratio. Transthoracic echocardiography revealed normal left ventricle systolic function (ejection fraction=60%) and mildly enlarged left ventricular dimensions (end-diastolic diameter=56 mm, end-systolic diameter=36 mm). Although systolic pulmonary artery pressure was 50 mm Hg, dimensions of the right heart chambers were normal. Important findings of the transthoracic echocardiography were found to be present at the mitral valve and left atrium. Mitral valve stenosis (planimetric mitral valve area=1.5 cm2), severe mitral regurgitation (3+), and huge left atrium with dimensions of 13×13 cm were determined (Figure 1). It was thought that the patient had hoarseness attributable to compression of the left recurrent laryngeal nerve by the huge left atrium. That hypothesis was proven by the flexible fiberoptic laryngoscopy, which showed paralytic left vocal cord (Figure 2, Movie). Because of these findings, the patient underwent operation for mitral valve replacement and atrial reconstruction. No complications occurred in the postoperative period. The patient’s voice quality improved somewhat, but it did not become totally normal. Cardiovocal syndrome or Ortner’s syndrome is a clinical condition with hoarseness attributable to left recurrent laryngeal nerve palsy in cardiovascular diseases. In our patient, nerve palsy developed because of compression of a very big left atrium.
The online-only Data Supplement, consisting of a movie, is available with this article at http://circ.ahajournals.org/cgi/content/full/115/10/e318/DC1.