Hoarseness in a patient with aortic arch aneurysm and multiple interventions: A case report of Ortner's syndrome

Ortner's syndrome, or cardiovocal syndrome, is an uncommon cause of hoarseness resulting from left recurrent laryngeal nerve palsy due to cardiovascular pathology. We present the case of a 78-year-old male with systemic hypertension, chronic kidney disease, and a history of multiple complex aortic repairs, including Stanford type A dissection repair, thoracoabdominal aortic aneurysm reconstruction, and infrarenal endovascular repair. He developed progressive hoarseness and dysphagia over four months. Videolaryngoscopy revealed left vocal fold paresis, and computed tomography angiography demonstrated a 53-mm aortic arch aneurysm with type IA endoleak adjacent to the recurrent laryngeal nerve. The patient underwent zone 0 thoracic endovascular aortic repair with parallel stenting of the brachiocephalic trunk and left carotid artery, and left subclavian artery occlusion. Hoarseness improved significantly by postoperative day one. This case highlights the importance of considering Ortner's syndrome in patients with unexplained hoarseness and aortic disease, as prompt endovascular intervention can achieve rapid symptomatic relief, even before aneurysm sac regression occurs. To our knowledge, Ortner's syndrome occurring after three extensive aortic repairs, including open thoracoabdominal reconstruction and staged endovascular procedures, has not been previously reported. • Ortner's syndrome is a rare but clinically relevant complication of aortic arch aneurysms. • The importance of multidisciplinary collaboration for timely diagnosis and management is essential. • Rapid symptomatic improvement after advanced endovascular treatment in a high-risk/reoperative case is feasible.