Do pre-adenotonsillectomy echocardiographic findings change postoperatively in children with severe adenotonsillar hypertrophy

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. 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. 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. Severe chronic hypertrophic adenotonsillar tissue caused higher tricuspid regurgitation pressure and mean pulmonary arterial pressure

Subclinical pulmonary hypertension in children with obstructive adenotonsillar hypertrophy

Adenotonsillar hypertrophy [ATH] is the most common cause of upper airway obstruction and obstructive sleep symptoms in children. The aim of this study is to compare pre-adentonsillectomy echocardiographic findings with postoperative findings. Fifty five children with adnotonsillar hypertrophy and obstructive-sleep apnea symptoms [aged 4 to14 years, 35 males, 20 females] were randomly selected from Aug 2007 to November 2008. Preoperatively echocardiography was performed for all patients by the same pediatric cardiologist. Patients with positive findings were followed and again echocardiography was performed separately one month and six months after operation. All the patients' parents complained about severe open mouth snoring, agitated sleep and hyperpnoea. No complaints of apnea were reported. Tonsillar grades of all cases were of Ill or N. The preoperative mean pulmonary arterial pressure levels of the 4[7.3%] children were higher than normal range [25mmhg] and it significantly decreased after operation [P<0.0001 Npar test] [Preoperative MPAP = 32 +/- 3 mmHg, and six months postoperative follow up, MPAP=11 +/- 5 mmHg]. The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation [p 0.0001 preoperative TR=34 +/- 8 mmHg postoperative TR=19 +/- 6mmhg] Acceleration time /Ejection time [AC/ET] in these 7patient were lower than 0.4. This study showed that chronic symptomatic obstructive hypertrophy of adenotonsillar tissue results in higher tricuspid regurgitation pressure and mean pulmonary arterial pressure, which could be relieved by adenotonsillectomy