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Do pre-adenotonsillectomy echocardiographic findings change postoperatively in children with severe adenotonsillar
Yalda Jabbari Moghaddam1, Shamsi Ghaffari Bavil, Khosrou Abavisani
1Department of Otolaryngology-Head and Neck Surgery, Tabriz University of Medical Sciences, Iran.
Insights
Adenotonsillar hypertrophy in children can elevate pulmonary arterial pressure and tricuspid regurgitation. Adenotonsillectomy significantly improves these echocardiographic findings, resolving airway obstruction symptoms.
Area of Science:
- Pediatric Cardiology
- Otolaryngology
- Sleep Medicine
Background:
- Adenotonsillar hypertrophy is a common childhood condition causing upper airway obstruction.
- Severe cases can lead to obstructive sleep apnea symptoms.
- Echocardiographic changes associated with this condition require evaluation.
Purpose of the Study:
- To assess echocardiographic findings before and after adenotonsillectomy in children with adenotonsillar hypertrophy.
- To evaluate the impact of surgery on pulmonary arterial pressure and tricuspid regurgitation.
Main Methods:
- 55 children (3-11 years) with adenotonsillar hypertrophy and obstructive symptoms underwent preoperative echocardiography.
- A control group of 55 children without adenotonsillar disease was evaluated.
- Echocardiography was repeated one month and six months post-adenotonsillectomy.
Main Results:
- Preoperative mean pulmonary arterial pressure (MPAP) was elevated in 7.3% of patients and significantly decreased post-surgery (32 ± 3 to 11 ± 5 mm Hg).
- Preoperative tricuspid regurgitation (TR) pressure was elevated in 7 children and significantly decreased post-surgery (34 ± 8 to 19 ± 6 mm Hg).
- Control group echocardiography findings remained normal.
Conclusions:
- Severe chronic adenotonsillar hypertrophy is linked to elevated tricuspid regurgitation pressure and mean pulmonary arterial pressure.
- Adenotonsillectomy effectively reverses these echocardiographic abnormalities.
- Surgery resolves symptoms associated with airway obstruction due to adenotonsillar hypertrophy.
Purpose:
Hypertrophy of adenotonsillar tissue is one of the most common problems in childhood age and causes upper airway obstruction and even obstructive sleep apnea symptoms in severe forms. The aim of this study is to evaluate the changes of pre-adentonsillectomy echocardiographic findings after operation.
Material And Methods:
From August 2007 to November 2008, 55 children with adenotonsillar hypertrophy and obstructive-sleep symptoms (aged 3-11 years old of which 35 were males and 20 females) were randomly selected. Preoperatively echocardiography was performed for all patients by the pediatric cardiologist. In control group 55 children who referred to otolaryngology clinic because of non adenotonsillar related disease evaluated. One month and six months after operation, patients with positive findings were followed up and again echocardiography was performed separately.
Results:
No complaints of apnea were reported. Tonsillar grades of all cases were type III or IV. The preoperative mean pulmonary arterial pressure levels of the 4 (7.3%) children were higher than normal range (25 mm Hg) and it decreased significantly after operation (P < 0.000) (Preoperative MPAP = 32 ± 3 mm Hg, and six months postoperative follow up, MPAP = 11 ± 5 mm Hg). All the patients' parents complained about severe open mouth snoring, agitated sleep and hyperpnoea of their children. The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation (P < 0.000 preoperative TR = 34 ± 8 mm Hg postoperative TR = 19 ± 6 mm Hg). AC/ET in these seven patients were lower than 0.4. In control group echocardiography findings are normal.
Conclusion:
Severe chronic hypertrophic adenotonsillar tissue caused higher tricuspid regurgitation pressure and mean pulmonary arterial pressure.
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