Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: the so-called iatrogenic Ortner's (cardiovocal) syndrome

Abstract

Background: The clinical characteristics and outcomes of hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation have not been systematically elucidated.

Methods: The literature of hoarseness following cardiovascular surgery, intervention, and maneuver and intubation published between 1980 and 2011 was comprehensively retrieved in the MEDLINE database and the Google and Highwire Press search engines.

Results: The so-called "iatrogenic Ortner's (cardiovocal) syndrome" developed 0-7 (2.33 ± ± 2.66) days following cardiovascular surgery, intervention, maneuver and endotracheal intubation with an incidence of 10.15%. The most common symptoms associated with hoarseness were stridor (49.45%) and aspiration (15.38%). Patent ductus arteriosus ligation and otherwise congenital heart disease repair were the two main causes leading to such a complication. Patients' hoarse voice spontaneously resolved in 70.52%, and persisted in 33.61% of the patients. Treatment of the hoarseness included gelfoam/teflon injection, intravenous steroid therapy, type 1 thyroplasty and arytenoid adduction. Hoarseness recovered in 46.67%, improved in 13.33%, and persisted in 40%.

Conclusions: The recurrent laryngeal nerve was often injured following cardiovascular surgery, intervention, maneuver and endotracheal intubation. Care must be taken during the manipulations in order to avoid the nerve injury. The so-called "iatrogenic Ortner's (cardiovocal) syndrome" was a wrong concept as it did not meet the satisfaction of a main element "cardiovascular disease as an underlying cause of hoarseness" of the definition of Ortner's (cardiovocal) syndrome defined by Ortner in 1897. It was actually an immediate vocal cord complication following cardiovascular manipulation.