Ortner syndrome associated with aortic pseudoaneurysm after repair of aortic coarctation 30 years previously.

A healthy 48-year-old woman with hypertension was referred to our hospital because of an aortic pseudoaneurysm. She had undergone a replacement of the descending aorta by a 16-mm Dacron graft for aortic coarctation via a left thoracotomy 30 years before. Sudden onset of hoarseness had been presented 1 month previously, and exploration by flexible fiberoptic laryngoscopy for the causes of hoarseness revealed paralytic left vocal cord (Figure 1 and online-only Data Supplement Movie I). Three-dimensional computed tomography showed aortic pseudoaneurysm with a maximum diameter of 50 mm distal to the left subclavian artery, indicating that the pseudoaneurysm had possibly developed at the proximal anastomotic site of a previous operation (Figure 2), and the diameter of the previous Dacron prosthetic graft had dilated by 1.3 times. On admission, laboratory examinations were within normal limits. Transthoracic echocardiography demonstrated moderate aortic valve regurgitation with a left ventricular ejection fraction of 62%. We assumed that hoarseness occurred because of compression of the left recurrence laryngeal nerve by aortic pseudoaneurysm. A diagnosis of Ortner syndrome associated with aortic pseudoaneurysm was made.