Two cases of severe mitral stenosis with both hoarseness, caused by left vocal cord palsy, and dysphagia are described. This combination in the same patient has not, to our knowledge, been previously described. Previous studies have firmly established that vocal cord paralysis in mitral stenosis is a result of compression of the left recurrent laryngeal nerve as it passes around the aortic arch. It is suggested that dysphagia may also develop as a result of neurological damage, in this case to autonomic nerve plexuses supplying the oesophagus, leading to abnormal peristalsis and enabling external compression by a tense left atrium sufficient to cause symptoms
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