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To raise awareness of Ortner’s Syndrome.A case reportA 31 year old female patient presented with an untreated congenital ostium primum ASD, pulmonary hypertension and hoarseness. Her chief complaints were 2 weeks of shortness of breath and 5 years of hoarseness. On cardiovascular examination, we could hear wide-fixed splitting with heave, S2 was sharper and louder than S1, pansystolic murmur on apex radiating to axilla, and crescendo-decrescendo systolic murmur on right sternal border. Echocardiography showed an ostium primum ASD, bidirectional shunt, moderate pulmonary hypertension, severe mitral regurgitation, and severe tricuspid regurgitation. Cardiac catheterization and oxygen test results in low flow high resistance, and non reactive oxygen test. Direct laryngoscopy revealed left vocal fold paralysis.Hoarseness secondary to laryngeal nerve compression in cardiovascular disease may correlate with a poorer prognosis. Awareness of vocal changes in the setting of cardiovascular disease will assist in early diagnosis and treatment and so improve prognosis. Direct laryngoscopy should be routinely performed in these cases.